Provider Demographics
NPI:1588805824
Name:MEDINA, DAVID ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTONIO
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:438 N CAPEN AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3013
Mailing Address - Country:US
Mailing Address - Phone:216-883-9303
Mailing Address - Fax:407-641-9566
Practice Address - Street 1:1836 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4256
Practice Address - Country:US
Practice Address - Phone:407-883-9303
Practice Address - Fax:407-641-9566
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1123362084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry