1548379712 NPI number — DR. FLORIANO PUTIGNA DO

Table of content: DR. FLORIANO PUTIGNA DO (NPI 1548379712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548379712 NPI number — DR. FLORIANO PUTIGNA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTIGNA
Provider First Name:
FLORIANO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1548379712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2253 BAY LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787-9051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-513-9386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 WINDERLEY PL STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751-7406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-875-0555
Provider Business Practice Location Address Fax Number:
407-875-0244
Provider Enumeration Date:
08/30/2006

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: 207PE0004X , with the licence number:  OS8905 , 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: G54849 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 633709590A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1447352778 . This is a "NPI - CSRA EMERGENCY PHYS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52168056002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 345561 . This is a "WELLCARE OF GA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10063009 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000241600 . 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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