Healthcare Provider Details

I. General information

NPI: 1013995687
Provider Name (Legal Business Name): DWAYNE FELIX LEDESMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 BELLARUS WAY SUITE 102
TRINITY FL
34655-1783
US

IV. Provider business mailing address

8141 BELLARUS WAY SUITE 102
TRINITY FL
34655-1783
US

V. Phone/Fax

Practice location:
  • Phone: 727-845-3555
  • Fax: 727-842-3556
Mailing address:
  • Phone: 727-845-3555
  • Fax: 727-842-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 80320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: