Provider Demographics
NPI:1154489839
Name:BELLIDO, ALEX (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BELLIDO
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 1:2051 PREVATT ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6141
Mailing Address - Country:US
Mailing Address - Phone:352-589-5697
Mailing Address - Fax:352-589-7218
Practice Address - Street 1:2051 PREVATT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6141
Practice Address - Country:US
Practice Address - Phone:352-589-5697
Practice Address - Fax:352-589-7218
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 71033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32192BMedicare PIN
FL32192AMedicare PIN