Provider Demographics
NPI:1073659934
Name:ATLAS, DEIRDRE J (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:J
Last Name:ATLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:27200 IMPERIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5801
Mailing Address - Country:US
Mailing Address - Phone:239-482-4673
Mailing Address - Fax:239-444-1111
Practice Address - Street 1:27200 IMPERIAL PKWY
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5801
Practice Address - Country:US
Practice Address - Phone:239-482-4673
Practice Address - Fax:239-444-1111
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME85246207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF88537Medicare UPIN