Provider Demographics
NPI:1134338908
Name:SUPLICY, FELIPE PORTO DE SOUZA (MD)
Entity type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:PORTO DE SOUZA
Last Name:SUPLICY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 NW 51ST ST
Mailing Address - Street 2:120
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4333
Mailing Address - Country:US
Mailing Address - Phone:808-489-1187
Mailing Address - Fax:352-265-3285
Practice Address - Street 1:705 N DIVISION ST NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1454
Practice Address - Country:US
Practice Address - Phone:808-489-1187
Practice Address - Fax:352-265-3285
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA647632084P0800X
HIMDR-48222084P0800X
FLTRN141282084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry