MEDICARE: DIEDRE T CAGLE M.D.

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
1	207VG0400X	Gynecology Physician	ME 88175	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	U1375S	OTHER	FL	MEDICARE TYPE - UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P01125564	OTHER	FL	RR MCR
3	37307	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1144215823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEDRE T CAGLE M.D.

Provider Business Mailing Address
First Line	:	15215 CORTEZ BLVD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34613-6072
Country	:	US
Telephone Number	:	352-799-0046
Fax Number	:	352-799-0115

Provider Business Practice Location Address
First Line	:	4270 LAKE IN THE WOODS DR
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34607-2501
Country	:	US
Telephone Number	:	352-597-7249
Fax Number	:	352-597-9523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/08/2013

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Directions to “ DIEDRE T CAGLE M.D.” Practice Location

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