MEDICARE: INFECTIOUS DISEASE CONSULTANTS OF ST. PETERSBURG, P.A.

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	207RI0200X	Infectious Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CB6866	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5600211	OTHER		GHI
2	34252	OTHER	FL	BLUE CROSS/BLUE SHIELD FL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982637195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFECTIOUS DISEASE CONSULTANTS OF ST. PETERSBURG, P.A.

Provider Business Mailing Address
First Line	:	4604 29TH ST E
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-9793
Country	:	US
Telephone Number	:	941-845-4572
Fax Number	:	941-845-4572

Provider Business Practice Location Address
First Line	:	4604 29TH ST E
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-9793
Country	:	US
Telephone Number	:	941-845-4572
Fax Number	:	941-845-4572

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLINTON DOUGLAS HOLDER
Credential	:	M.D.
Telephone Number	:	941-845-4572

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/24/2014

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1194722983 — DR. JAMES A BRILES M.D.
Practice Location Address:

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Directions to “INFECTIOUS DISEASE CONSULTANTS OF ST. PETERSBURG, P.A. ” Practice Location

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