Provider Demographics
NPI:1538558119
Name:M PATRICIA BEDOYA MD
Entity type:Organization
Organization Name:M PATRICIA BEDOYA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BEDOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-752-0442
Mailing Address - Street 1:183 NW GWEN LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3711
Mailing Address - Country:US
Mailing Address - Phone:386-752-0442
Mailing Address - Fax:386-719-4752
Practice Address - Street 1:183 NW GWEN LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3711
Practice Address - Country:US
Practice Address - Phone:386-752-0442
Practice Address - Fax:386-719-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12040OtherFLORIDA BLUE
FL202713500Medicaid
FL202713500Medicaid
FLD52150Medicare UPIN