Individual
EDISON JOSE CANO CEVALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5647 HOLLYWOOD BLVD, HOLLYWOOD, FL 33021-6325
(954) 276-1616
(954) 276-0186
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME151652
FL
207RI0200X
Infectious Disease Physician
63792
MN
207RI0200X
Infectious Disease Physician
Primary
ME151652
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111150900
—
FL
Enumeration date
08/08/2015
Last updated
03/09/2022
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