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NPI Code Detail

MEDICARE: DR. GUIDO F NODAL JR. M.D.

MEDICARE: DR. GUIDO F NODAL JR. 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
12084P0805XGeriatric Psychiatry PhysicianME0050170FL
22084P0800XPsychiatry PhysicianME0050170FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427064435
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GUIDO F NODAL JR. M.D.
Provider Business Mailing Address
First Line : 3300 S FISKE BLVD
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-4306
Country : US
Telephone Number : 321-434-8078
Fax Number : 321-434-8075
Provider Business Practice Location Address
First Line : 1425 MALABAR RD NE
Second Line :
City : PALM BAY
State : FL
Zip : 32907-2506
Country : US
Telephone Number : 305-296-6668
Fax Number : 305-296-6797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 09/15/2020

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