Provider Demographics
NPI:1760709703
Name:MALPARTIDA, EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:MALPARTIDA
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 1:2626 TAMPA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3155
Mailing Address - Country:US
Mailing Address - Phone:727-789-3300
Mailing Address - Fax:727-787-3454
Practice Address - Street 1:2626 TAMPA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3155
Practice Address - Country:US
Practice Address - Phone:727-789-3300
Practice Address - Fax:727-787-3454
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024403207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052609600Medicaid
FLD56281Medicare UPIN
FL52828Medicare PIN