Provider Demographics
NPI:1518493667
Name:INFECTIOUS DISEASES & TROPICAL MEDICINE PA
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES & TROPICAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-471-9633
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3883
Mailing Address - Country:US
Mailing Address - Phone:904-471-9633
Mailing Address - Fax:904-471-8808
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:904-471-9633
Practice Address - Fax:904-471-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117467207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty