Healthcare Provider Details

I. General information

NPI: 1215954169
Provider Name (Legal Business Name): ALLAN C HONCULADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 E CENTRAL AVE
WINTER HAVEN FL
33880-3054
US

IV. Provider business mailing address

321 E ROBERTSON ST
BRANDON FL
33511-5253
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-9066
  • Fax: 863-293-7887
Mailing address:
  • Phone: 813-685-2191
  • Fax: 813-689-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME0073045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: