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General NPI Number Information
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NPI Number | 1134338908
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Entity Type | Individual
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Provider Name | FELIPE PORTO DE SOUZA SUPLICY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 705 N DIVISION ST NW
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City | ROME
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State | GA
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Zip | 30165-1454
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Country | US
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Telephone | 808-489-1187
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Fax | 352-265-3285
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Provider Business Mailing Address
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Address Line | 4000 NW 51ST ST 120
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City | GAINESVILLE
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State | FL
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Zip | 32606-4333
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Country | US
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Telephone | 808-489-1187
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Fax | 352-265-3285
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 64763
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDR-4822
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | TRN14128
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License Number State | FL
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