Healthcare Provider Details

I. General information

NPI: 1518257021
Provider Name (Legal Business Name): PATRICIA BEDOYA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 JOG RD STE 205
DELRAY BEACH FL
33446-2170
US

IV. Provider business mailing address

15340 JOG RD STE 205
DELRAY BEACH FL
33446-2170
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-7600
  • Fax: 561-638-6787
Mailing address:
  • Phone: 561-638-7600
  • Fax: 561-638-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: