Provider Demographics
NPI:1629173158
Name:BEDOYA, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:BEDOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 SW STATE ROAD 247
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-8308
Mailing Address - Country:US
Mailing Address - Phone:386-755-7595
Mailing Address - Fax:386-755-7561
Practice Address - Street 1:876 SW STATE ROAD 247
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-8308
Practice Address - Country:US
Practice Address - Phone:386-755-7595
Practice Address - Fax:386-755-7561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81531207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260566000Medicaid
FL6385720001Medicare NSC
51917YMedicare PIN
E64919Medicare UPIN