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NPI Code Detail

MEDICARE: MRS. DANA SUZANNE BLEDSOE-GONZALEZ LMT

MEDICARE:  MRS. DANA SUZANNE BLEDSOE-GONZALEZ  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMA0020445FL

General Provider Information

NPI Number : 1013070630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DANA SUZANNE BLEDSOE-GONZALEZ LMT
Provider Business Mailing Address
First Line : 1010 US HIGHWAY 98 W
Second Line :
City : FROSTPROOF
State : FL
Zip : 33843-9326
Country : US
Telephone Number : 863-443-4550
Fax Number :
Provider Business Practice Location Address
First Line : 930 W MAIN ST
Second Line :
City : AVON PARK
State : FL
Zip : 33825-3312
Country : US
Telephone Number : 863-443-4550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. DANA SUZANNE BLEDSOE-GONZALEZ LMT” Practice Location

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