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General NPI Number Information
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NPI Number | 1689778706
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Entity Type | Individual
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Provider Name | JAIME CANCEL MD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 4235 KINGS HIGHWAY SUITE 103
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-8421
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Country | US
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Telephone | 941-613-1777
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Fax | 941-613-1779
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Provider Business Mailing Address
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Address Line | 4235 KINGS HIGHWAY SUITE 103
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-8421
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Country | US
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Telephone | 941-613-1777
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Fax | 941-613-1779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME137658
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME137658
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License Number State | FL
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