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NPI Code Detail

MEDICARE: DR. IAN S CACCAM M.D.

MEDICARE: DR. IAN S CACCAM M.D.
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
1207P00000XEmergency Medicine PhysicianME0087735FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
179023OTHERFLBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699765131
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IAN S CACCAM M.D.
Provider Business Mailing Address
First Line : 1706 BELMONTE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-3118
Country : US
Telephone Number : 904-399-0906
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8202
Country : US
Telephone Number : 904-202-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 05/21/2008

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Directions to “ DR. IAN S CACCAM M.D.” Practice Location

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