Provider Demographics
NPI:1164494316
Name:BIDWELL, PATRICE TALLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:TALLEY
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:PATRICE
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 919030
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9030
Mailing Address - Country:US
Mailing Address - Phone:850-656-4277
Mailing Address - Fax:850-656-4276
Practice Address - Street 1:2010 FLEISCHMANN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4599
Practice Address - Country:US
Practice Address - Phone:850-552-0608
Practice Address - Fax:850-552-0925
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47516207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37487OtherBLUE CROSS
FL37487OtherBLUE CROSS
FL37487YMedicare PIN