Provider Demographics
NPI:1760657688
Name:WHITESIDE, AMAPOLA DUMLAO (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAPOLA
Middle Name:DUMLAO
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-6226
Mailing Address - Fax:407-438-0507
Practice Address - Street 1:221 SW STONEGATE TER
Practice Address - Street 2:105
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3463
Practice Address - Country:US
Practice Address - Phone:386-752-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116181207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN496AMedicare PIN