Healthcare Provider Details

I. General information

NPI: 1386922938
Provider Name (Legal Business Name): VICTOR HUGO URBIETA CACERES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 ALICE ST
WAYCROSS GA
31501-6208
US

IV. Provider business mailing address

1908 ALICE ST
WAYCROSS GA
31501-6208
US

V. Phone/Fax

Practice location:
  • Phone: 912-338-6010
  • Fax: 912-287-2796
Mailing address:
  • Phone: 912-338-6010
  • Fax: 912-287-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number06959
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: