Healthcare Provider Details

I. General information

NPI: 1659114239
Provider Name (Legal Business Name): LUIS ANTHONY ACEVEDO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TILGHMAN DR
DUNN NC
28334-5510
US

IV. Provider business mailing address

800 TILGHMAN DR
DUNN NC
28334-5510
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-6423
  • Fax:
Mailing address:
  • Phone: 910-891-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRTL24-1026
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: