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General NPI Number Information
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NPI Number | 1386968121
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASES CENTER OF FLORIDA, PLLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 204 E 19TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-784-2105
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Fax | 850-522-9453
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Provider Business Mailing Address
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Address Line | 204 E 19TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-4707
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Country | US
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Telephone | 850-784-2105
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Fax | 850-522-9453
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. PALEP RAO
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Credential | M.D.
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Telephone | 850-784-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800025728
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License Number State | FL
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