Individual
JUSTIN STODDARD BIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5880 49TH ST N, SUITE N-104, ST PETERSBURG, FL 33709-2150
(727) 528-6100
(727) 528-7895
Mailing address
5880 49TH ST N, SUITE N-104, ST PETERSBURG, FL 33709-2150
(727) 528-6100
(727) 528-7895
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102405
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291591000
—
FL
01
—
U0897Y
MEDICARE PTAN
FL
Enumeration date
08/20/2006
Last updated
10/29/2021
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