Individual
DR. IAN S CACCAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 202-2000
Mailing address
1706 BELMONTE AVE, JACKSONVILLE, FL 32207-3118
(904) 399-0906
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME0087735
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000970219C
—
GA
05
—
340389100
—
FL
01
—
79023
BCBS
FL
Enumeration date
10/26/2005
Last updated
05/21/2008
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