Healthcare Provider Details

I. General information

NPI: 1801179528
Provider Name (Legal Business Name): PABLO ACEVEDO, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 MEDICAL DR
HUDSON FL
34667-6502
US

IV. Provider business mailing address

9601 HIGHLAND RIDGE DR
HUDSON FL
34667-4243
US

V. Phone/Fax

Practice location:
  • Phone: 727-869-5551
  • Fax: 727-868-2329
Mailing address:
  • Phone: 727-919-7681
  • Fax: 727-863-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME56069
License Number StateFL

VIII. Authorized Official

Name: DR. PABLO E ACEVEDO
Title or Position: MANAGER
Credential: M.D.
Phone: 727-919-7681