Provider Demographics
NPI:1275716573
Name:LAIOLO, BETINA P (MD)
Entity Type:Individual
Prefix:DR
First Name:BETINA
Middle Name:P
Last Name:LAIOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7599 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3263
Mailing Address - Country:US
Mailing Address - Phone:863-324-4725
Mailing Address - Fax:863-229-7514
Practice Address - Street 1:7599 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884
Practice Address - Country:US
Practice Address - Phone:863-324-4725
Practice Address - Fax:863-324-4783
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007032916208D00000X
FLME109722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO331150626OtherPTAN
MO000010626OtherGROUP PTAN
MO1275716573OtherSITE NPI
MO207022609Medicaid
FLME109722OtherLICENSE
MO331150626OtherPTAN
FLME109722OtherLICENSE