MEDICARE: DR. CRAIG DEPODESTA D.O.

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	207Q00000X	Family Medicine Physician	OS8042	FL

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	:	1497750376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG DEPODESTA D.O.

Provider Business Mailing Address
First Line	:	PO BOX 132
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33061-0132
Country	:	US
Telephone Number	:	954-530-1600
Fax Number	:	954-306-8234

Provider Business Practice Location Address
First Line	:	231B COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4441
Country	:	US
Telephone Number	:	954-530-1600
Fax Number	:	954-306-8234

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/05/2009

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