MEDICARE: BOBBY JOHN ARDILA PA-C

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	363AS0400X	Surgical Physician Assistant	PA9102779	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	:	1699737783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY JOHN ARDILA PA-C

Provider Business Mailing Address
First Line	:	410 CELEBRATION PL
Second Line	:	SUITE 200
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5433
Country	:	US
Telephone Number	:	407-303-4673
Fax Number	:	407-303-4674

Provider Business Practice Location Address
First Line	:	410 CELEBRATION PL
Second Line	:	SUITE 200
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5433
Country	:	US
Telephone Number	:	407-303-4673
Fax Number	:	407-303-4674

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/20/2009

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