Provider Demographics
NPI:1942484688
Name:DEMOLA, PHILIP M (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:DEMOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7955 SPYGLASS HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8249
Mailing Address - Country:US
Mailing Address - Phone:321-751-3389
Mailing Address - Fax:321-775-1363
Practice Address - Street 1:7955 SPYGLASS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8249
Practice Address - Country:US
Practice Address - Phone:321-751-3389
Practice Address - Fax:321-775-1363
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050541208100000X
PAOT012076208D00000X
FLOS14694208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS14694OtherFLORIDA MEDICAL LICENSE
FL6470221OtherUHC
FLVE7HVOtherFLORIDA BLUE
FL9356777OtherCIGNA