Provider Demographics
NPI:1851333744
Name:DIBLASIO, GARY HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HENRY
Last Name:DIBLASIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:701 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5215
Mailing Address - Country:US
Mailing Address - Phone:561-863-2828
Mailing Address - Fax:561-863-2814
Practice Address - Street 1:701 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5215
Practice Address - Country:US
Practice Address - Phone:561-863-2828
Practice Address - Fax:561-863-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME740522081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42670AMedicare ID - Type Unspecified
FLB58060Medicare UPIN