Provider Demographics
NPI:1346205812
Name:DIGIACOMO, WAYNE PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:PETER
Last Name:DIGIACOMO
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 1:3001 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5155
Mailing Address - Country:US
Mailing Address - Phone:954-456-4888
Mailing Address - Fax:954-456-9721
Practice Address - Street 1:3001 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5155
Practice Address - Country:US
Practice Address - Phone:954-456-4888
Practice Address - Fax:954-456-9721
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034571207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0034571OtherSTATE LICENSE
FL065501599Medicaid
FL065501599Medicaid
FLD57687Medicare UPIN