Healthcare Provider Details

I. General information

NPI: 1548212400
Provider Name (Legal Business Name): PATRICIA BEDOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 NW GWEN LAKE AVE
LAKE CITY FL
32055-3711
US

IV. Provider business mailing address

183 NW GWEN LAKE AVE
LAKE CITY FL
32055-3711
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-0442
  • Fax: 386-719-4752
Mailing address:
  • Phone: 386-752-0442
  • Fax: 386-719-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0019743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: