MEDICARE: RICARDO BEDOYA-GARCIA MD

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	2085R0202X	Diagnostic Radiology Physician	E0400	TX
2	2085R0202X	Diagnostic Radiology Physician	ME17760	FL
3	2085R0202X	Diagnostic Radiology Physician	056974	GA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497728356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO BEDOYA-GARCIA MD

Provider Business Mailing Address
First Line	:	PO BOX 691
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-0691
Country	:	US
Telephone Number	:	386-752-9144
Fax Number	:	386-752-5881

Provider Business Practice Location Address
First Line	:	183 NW GWEN LAKE AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3711
Country	:	US
Telephone Number	:	386-752-9144
Fax Number	:	386-752-5881

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	06/17/2008

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Directions to “ RICARDO BEDOYA-GARCIA MD” Practice Location

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