Provider Demographics
NPI:1538377809
Name:GIRI, VISIT SUPANICH (MD)
Entity type:Individual
Prefix:DR
First Name:VISIT
Middle Name:SUPANICH
Last Name:GIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VISIT
Other - Middle Name:S
Other - Last Name:GIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:603 SCENIC CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-3060
Mailing Address - Country:US
Mailing Address - Phone:850-547-8500
Mailing Address - Fax:850-547-8515
Practice Address - Street 1:603 SCENIC CIRCLE DR
Practice Address - Street 2:FLORIDA DEPT. OF HEALTH/HOLMES COUNTY HEALTH DEPT.
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-3060
Practice Address - Country:US
Practice Address - Phone:850-547-8500
Practice Address - Fax:850-547-8515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN208208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice