1598768673 NPI number — DR. BENY LESTER GUEDES MD

Table of content: DR. BENY LESTER GUEDES MD (NPI 1598768673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598768673 NPI number — DR. BENY LESTER GUEDES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUEDES
Provider First Name:
BENY
Provider Middle Name:
LESTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598768673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 LEE RD STE 165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32789-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-975-0410
Provider Business Mailing Address Fax Number:
407-975-0411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E ROLLINS ST
Provider Second Line Business Practice Location Address:
FLORIDA HOSPITAL PEDIATRIC INTENSIVISTS
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-975-0410
Provider Business Practice Location Address Fax Number:
407-975-0411
Provider Enumeration Date:
05/23/2005

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: 2080P0203X , with the licence number:  ME15959 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: ME15959 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 056506700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 038603101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".