Provider Demographics
NPI:1699302745
Name:CAVACECE, CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:CAVACECE
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:SAN ANTONIO MILITARY MEDICAL CENTER
Mailing Address - Street 2:3551 ROGER BROOKE DR.,
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, IM RESIDENCY
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7805
Practice Address - Country:US
Practice Address - Phone:210-916-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101274608207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine