Provider Demographics
NPI:1548205651
Name:DIGESTIVE DISEASES CENTER OF FLORIDA, PLLC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASES CENTER OF FLORIDA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PALEP
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-784-2105
Mailing Address - Street 1:204 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4707
Mailing Address - Country:US
Mailing Address - Phone:850-763-5409
Mailing Address - Fax:850-763-7129
Practice Address - Street 1:204 E 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-763-5409
Practice Address - Fax:850-763-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060615400Medicaid