Provider Demographics
NPI:1801880448
Name:DEPADUA, MARIA ELOISA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELOISA
Last Name:DEPADUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 COUNTY ROAD 17A W
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2164
Mailing Address - Country:US
Mailing Address - Phone:863-452-3060
Mailing Address - Fax:863-452-3069
Practice Address - Street 1:201 MAGNOLIA AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2943
Practice Address - Country:US
Practice Address - Phone:866-234-8534
Practice Address - Fax:863-229-7999
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME68809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378200000Medicaid
FL378200000Medicaid
FL378200000Medicaid