MEDICARE: DR. CARMELO CEDRES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	C10008672	DE
2	208D00000X	General Practice Physician	C10008672	DE
3	208000000X	Pediatrics Physician	ME53455	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578515359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMELO CEDRES MD

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-633-0460
Fax Number	:	904-633-0461

Provider Business Practice Location Address
First Line	:	6271 SAINT AUGUSTINE RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2555
Country	:	US
Telephone Number	:	904-633-0460
Fax Number	:	904-633-0461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/04/2018

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Directions to “ DR. CARMELO CEDRES MD” Practice Location

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