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General NPI Number Information
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NPI Number | 1538473053
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Entity Type | Organization
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Legal Business Name | GARY H DIBLASIO M D P A
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 5500 VILLAGE BLVD STE 101
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1961
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Country | US
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Telephone | 561-684-6565
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Fax | 561-684-3467
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Provider Business Mailing Address
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Address Line | 5500 VILLAGE BLVD STE 101
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1961
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Country | US
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Telephone | 561-684-6565
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Fax | 561-684-3467
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | GARY HENRY DIBLASIO
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Credential | M.D.
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Telephone | 561-684-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME74052
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License Number State | FL
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