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NPI Code Detail

MEDICARE: DR. GARY HENRY DIBLASIO M.D.

MEDICARE:  DR. GARY HENRY DIBLASIO  M.D.
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
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) PhysicianME74052FL

General Provider Information

NPI Number : 1851333744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY HENRY DIBLASIO M.D.
Provider Business Mailing Address
First Line : 701 NORTHLAKE BLVD
Second Line : SUITE 208
City : NORTH PALM BEACH
State : FL
Zip : 33408-5215
Country : US
Telephone Number : 561-863-2828
Fax Number : 561-863-2814
Provider Business Practice Location Address
First Line : 701 NORTHLAKE BLVD
Second Line : SUITE 208
City : NORTH PALM BEACH
State : FL
Zip : 33408-5215
Country : US
Telephone Number : 561-863-2828
Fax Number : 561-863-2814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 10/06/2011

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