Organization
DOMINIQUE MESIDOR MD P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE MESIDOR M.D. (PRESIDENT)
(727) 328-7400
Entity
Organization
Contact information
Practice address
1839 CENTRAL AVE, ST PETERSBURG, FL 33713-8900
(727) 896-1300
(727) 896-1311
Mailing address
PO BOX 16226, ST PETERSBURG, FL 33733-6226
(727) 896-1300
(727) 896-1311
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
ME86398
FL
2086S0127X
Trauma Surgery Physician
ME86398
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37818
BLUE SHIELD FLORIDA
FL
01
—
U1254X
MEDICARE
FL
Enumeration date
02/22/2007
Last updated
02/26/2008
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