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NPI Code Detail

MEDICARE: DIAGNOSTIC PATHOLOGY ASSOCIATES PA

MEDICARE: DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DD0960OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
294814OTHERFLBCBS OF FL

General Provider Information

NPI Number : 1306845060
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAGNOSTIC PATHOLOGY ASSOCIATES PA
Provider Business Mailing Address
First Line : 5755 HOOVER BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33634-5340
Country : US
Telephone Number : 866-944-0404
Fax Number :
Provider Business Practice Location Address
First Line : 600 E DIXIE AVE
Second Line :
City : LEESBURG
State : FL
Zip : 34748-5925
Country : US
Telephone Number : 352-323-5300
Fax Number :
Authorized Official
Title or Position : MD PRESIDENT
Name : DR. CLIFTON L BRIDGES JR.
Credential : MD
Telephone Number : 352-323-5300
Provider Enumeration Date : 07/15/2005
Last Update Date : 03/27/2008

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Directions to “DIAGNOSTIC PATHOLOGY ASSOCIATES PA ” Practice Location

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