Healthcare Provider Details

I. General information

NPI: 1306004270
Provider Name (Legal Business Name): LUIS JAIME CUERVO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 ARENDELL ST PO DRAWER 1619
MOREHEAD CITY NC
28557-2901
US

IV. Provider business mailing address

3500 ARENDELL ST PO DRAWER 1619
MOREHEAD CITY NC
28557-2901
US

V. Phone/Fax

Practice location:
  • Phone: 252-808-6177
  • Fax: 252-808-6637
Mailing address:
  • Phone: 252-808-6177
  • Fax: 252-808-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN3585
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2012-01277
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: