Provider Demographics
NPI:1548212400
Name:BEDOYA, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:BEDOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 NW GWEN LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3711
Mailing Address - Country:US
Mailing Address - Phone:386-752-0442
Mailing Address - Fax:386-719-4752
Practice Address - Street 1:183 NW GWEN LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3711
Practice Address - Country:US
Practice Address - Phone:386-752-0442
Practice Address - Fax:386-719-4752
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12040OtherPROVIDER ID
FL12040OtherPROVIDER ID