MEDICARE: MRS. DORENDA MELLYN MIDDLETON CRT

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	227800000X	Certified Respiratory Therapist	TT003783	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

General Provider Information

NPI Number	:	1538285549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORENDA MELLYN MIDDLETON CRT

Provider Business Mailing Address
First Line	:	PO BOX 1952
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-1952
Country	:	US
Telephone Number	:	386-438-5493
Fax Number	:	386-438-5493

Provider Business Practice Location Address
First Line	:	547 NE LAKE DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3446
Country	:	US
Telephone Number	:	386-438-5493
Fax Number	:	386-438-5493

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/09/2013

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