Healthcare Provider Details

I. General information

NPI: 1356347280
Provider Name (Legal Business Name): DAVID J DIPIAZZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 DUCK SLOUGH BLVD STE 102
NEW PORT RICHEY FL
34655-5003
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-1975
  • Fax: 727-375-1927
Mailing address:
  • Phone: 352-205-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME90068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: