Provider Demographics
NPI:1225309297
Name:RAUL P. PALOMADO, MD PA
Entity Type:Organization
Organization Name:RAUL P. PALOMADO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:PAGDATO
Authorized Official - Last Name:PALOMADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-375-2214
Mailing Address - Street 1:302 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834-5053
Mailing Address - Country:US
Mailing Address - Phone:863-375-2214
Mailing Address - Fax:863-375-2212
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:FL
Practice Address - Zip Code:33834-5053
Practice Address - Country:US
Practice Address - Phone:863-375-2214
Practice Address - Fax:863-375-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49281261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08534Medicare UPIN