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General NPI Number Information
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NPI Number | 1891793634
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Entity Type | Individual
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Provider Name | PHILIP V BACIDORE DO
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 520 S 7TH ST
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City | VINCENNES
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State | IN
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Zip | 47591-1038
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Country | US
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Telephone | 812-885-3243
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Fax | 812-885-3915
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Provider Business Mailing Address
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Address Line | 520 S 7TH ST
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City | VINCENNES
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State | IN
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Zip | 47591-1038
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Country | US
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Telephone | 812-885-3243
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Fax | 812-885-3915
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 02000845A
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License Number State | IN
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