Provider Demographics
NPI:1538161864
Name:CABEZUDO, IGNACIO NMI (MD)
Entity type:Individual
Prefix:
First Name:IGNACIO
Middle Name:NMI
Last Name:CABEZUDO
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:CHERRY HOSPITAL
Mailing Address - Street 2:1401 WEST ASH STREET
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-1078
Mailing Address - Country:US
Mailing Address - Phone:919-947-8236
Mailing Address - Fax:919-705-5140
Practice Address - Street 1:CHERRY HOSPITAL
Practice Address - Street 2:1401 WEST ASH STREET
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1078
Practice Address - Country:US
Practice Address - Phone:919-947-8236
Practice Address - Fax:919-705-5140
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-10-22
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-21
Provider Licenses
StateLicense IDTaxonomies
AZ29743208D00000X
NC2013-02327208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ636293Medicaid
AZ636293Medicaid
AZF95090Medicare UPIN