Provider Demographics
NPI:1538379854
Name:MACCEDO, FRANCIS YURI (MD)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:YURI
Last Name:MACCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANCISCO
Other - Middle Name:YURI BULCAO
Other - Last Name:MACEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1824 KING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4736
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:
Practice Address - Street 1:803 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6013
Practice Address - Country:US
Practice Address - Phone:352-530-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103676207RC0000X, 207RI0011X, 207UN0901X
NJ25MA11390200207RI0011X, 207RI0011X
KY53347207RC0000X
FLTRN10662390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002099900Medicaid
KY7100642340Medicaid
FLZ43Z8OtherBC/BS