=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568407104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELO JOSEPH BABBO D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2006
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 S HEATHWOOD DR STE A
-----------------------------------------------------
City | MARCO ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34145-5026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-8180
-----------------------------------------------------
Fax | 239-624-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26067
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84126-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-0400
-----------------------------------------------------
Fax | 239-624-0401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS17368
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------