1477559623 NPI number — JOHN NONDA KATOPODIS M.D.

Table of content: JEFF DOWLING (NPI 1487350013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477559623 NPI number — JOHN NONDA KATOPODIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KATOPODIS
Provider First Name:
JOHN
Provider Middle Name:
NONDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1477559623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-216-0100
Provider Business Mailing Address Fax Number:
850-201-4834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-216-0100
Provider Business Practice Location Address Fax Number:
850-201-4834
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME51240 , 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: 00000 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000 . This is a "BEECH STREET/CAPP CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000 . This is a "FOCUS HC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000659062A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009979020 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000 . This is a "SOUSTH CARE NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01106 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 04619 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00000 . This is a "HUMANA/CHOICE CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024476400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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