Provider Demographics
NPI:1063451433
Name:ACEBO, WALDO (MD)
Entity type:Individual
Prefix:
First Name:WALDO
Middle Name:
Last Name:ACEBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9851 NW 58TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2716
Mailing Address - Country:US
Mailing Address - Phone:305-403-1035
Mailing Address - Fax:305-403-1036
Practice Address - Street 1:9851 NW 58TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2716
Practice Address - Country:US
Practice Address - Phone:305-403-1035
Practice Address - Fax:305-403-1036
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E6088WMedicare ID - Type Unspecified
H46558Medicare UPIN