Provider Demographics
NPI:1497965420
Name:DAFFIN INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:DAFFIN INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:ALDERMAN
Authorized Official - Last Name:DAFFIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-4711
Mailing Address - Street 1:746 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2524
Mailing Address - Country:US
Mailing Address - Phone:850-763-4711
Mailing Address - Fax:850-763-0056
Practice Address - Street 1:746 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2524
Practice Address - Country:US
Practice Address - Phone:850-763-4711
Practice Address - Fax:850-763-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106442081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123524657OtherDR.DAFFIN'S NPI
FL72568OtherGROUP ID#
FL72568OtherPIN
FL040260500Medicaid
FL72568OtherGROUP ID#
FLD50722Medicare UPIN