Provider Demographics
NPI:1407997141
Name:ALEX F BELLIDO MD PA
Entity Type:Organization
Organization Name:ALEX F BELLIDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:F
Authorized Official - Last Name:BELLIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-589-5697
Mailing Address - Street 1:2051 PREVATT ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6141
Mailing Address - Country:US
Mailing Address - Phone:352-589-5697
Mailing Address - Fax:352-589-7218
Practice Address - Street 1:2051 PREVATT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6141
Practice Address - Country:US
Practice Address - Phone:352-589-5697
Practice Address - Fax:352-589-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8014Medicare PIN