Provider Demographics
NPI:1144290206
Name:REGALA, PHILIP T (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:REGALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1350 TAMIAMI TRL N
Mailing Address - Street 2:STE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5203
Mailing Address - Country:US
Mailing Address - Phone:239-325-1131
Mailing Address - Fax:239-262-5980
Practice Address - Street 1:1350 TAMIAMI TRL N
Practice Address - Street 2:STE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5203
Practice Address - Country:US
Practice Address - Phone:239-325-1131
Practice Address - Fax:239-262-5980
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME63476207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32870OtherBLUE CROSS
FL251729900Medicaid
FL32870ZMedicare PIN
FL32870OtherBLUE CROSS