MEDICARE: M PATRICIA BEDOYA 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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12040	OTHER	FL	FLORIDA BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538558119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M PATRICIA BEDOYA MD

Provider Business Mailing Address
First Line	:	183 NW GWEN LAKE AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3711
Country	:	US
Telephone Number	:	386-752-0442
Fax Number	:	386-719-4752

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	:	386-752-0442
Fax Number	:	386-719-4752

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIA P BEDOYA
Credential	:	M.D.
Telephone Number	:	386-752-0442

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	01/20/2015

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