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General NPI Number Information
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NPI Number | 1871614511
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Entity Type | Organization
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Legal Business Name | ABELARDO V. LACANO, MD, PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 FORTENBERRY RD
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3621
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Country | US
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Telephone | 321-452-8410
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Fax | 321-453-4938
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Provider Business Mailing Address
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Address Line | 300 FORTENBERRY RD
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3621
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Country | US
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Telephone | 321-452-8410
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Fax | 321-453-4938
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABELARDO VASQUEZ LACANO
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Credential | M.D.
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Telephone | 321-452-8410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME 20168
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License Number State | FL
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