Provider Demographics
NPI:1508036641
Name:PATRICK H. GUADIZ, MD, PA
Entity Type:Organization
Organization Name:PATRICK H. GUADIZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:HERMY
Authorized Official - Last Name:GUADIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-675-2148
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-0249
Mailing Address - Country:US
Mailing Address - Phone:863-675-2148
Mailing Address - Fax:863-675-7078
Practice Address - Street 1:920 W COWBOY WAY
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935
Practice Address - Country:US
Practice Address - Phone:863-675-2148
Practice Address - Fax:863-675-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI43647Medicare UPIN
K8702Medicare PIN