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General NPI Number Information
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NPI Number | 1790764272
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Entity Type | Individual
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Provider Name | DIMITRIOS PHILIPPES AGALIOTIS MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 1699 S 14TH ST STE 2
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-427-1370
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Fax |
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD ATTN: MANAGED CARE DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME0065592
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License Number State | FL
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