Provider Demographics
NPI:1912198664
Name:BIDOT, DAVID O (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:BIDOT
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:PO BOX 80808
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30366-0808
Mailing Address - Country:US
Mailing Address - Phone:787-525-6580
Mailing Address - Fax:
Practice Address - Street 1:3386 SHALLOWFORD RD NE
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3513
Practice Address - Country:US
Practice Address - Phone:787-525-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine