Provider Demographics
NPI:1912178922
Name:DE PADUA AND DE PADUA MD PA
Entity Type:Organization
Organization Name:DE PADUA AND DE PADUA MD PA
Other - Org Name:INDUSTRIAL MEDICINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAPOLEON
Authorized Official - Middle Name:G
Authorized Official - Last Name:DE PADUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-727-5120
Mailing Address - Street 1:1205 MONUMENT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7406
Mailing Address - Country:US
Mailing Address - Phone:904-727-5120
Mailing Address - Fax:904-727-5129
Practice Address - Street 1:1205 MONUMENT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7406
Practice Address - Country:US
Practice Address - Phone:904-727-5120
Practice Address - Fax:904-727-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040865261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99601Medicare PIN