Provider Demographics
NPI:1841246873
Name:BADIOLA, EVARISTO PLACEDES (MD)
Entity type:Individual
Prefix:DR
First Name:EVARISTO
Middle Name:PLACEDES
Last Name:BADIOLA
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 1:204 LAKE HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2632
Mailing Address - Country:US
Mailing Address - Phone:863-646-7733
Mailing Address - Fax:863-647-2648
Practice Address - Street 1:204 LAKE HARRIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2632
Practice Address - Country:US
Practice Address - Phone:863-646-7733
Practice Address - Fax:863-647-2648
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00479392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56162Medicare ID - Type Unspecified
FLD86060Medicare UPIN