1609111855 NPI number — DIGON DIABETES AND ENDOCRINOLOGY, P.A.

Table of content: (NPI 1609111855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609111855 NPI number — DIGON DIABETES AND ENDOCRINOLOGY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGON DIABETES AND ENDOCRINOLOGY, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609111855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 N CLYDE MORRIS BLVD
Provider Second Line Business Mailing Address:
SUITE 440
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-2781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-265-1908
Provider Business Mailing Address Fax Number:
386-872-4910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 N CLYDE MORRIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-2781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-265-1908
Provider Business Practice Location Address Fax Number:
386-872-4910
Provider Enumeration Date:
11/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIGON
Authorized Official First Name:
BENIGNO
Authorized Official Middle Name:
JOSE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
386-265-1908

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  ME090349 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1396760195 . This is a "NPI 1- INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".