Provider Demographics
NPI:1306845060
Name:DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-323-5300
Mailing Address - Street 1:5755 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5340
Mailing Address - Country:US
Mailing Address - Phone:866-944-0404
Mailing Address - Fax:
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-15
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD0960OtherRAILROAD MEDICARE
FL94814OtherBCBS OF FL
FLK7497Medicare PIN