Organization
INFECTIOUS DISEASE CONSULTANTS OF ST. PETERSBURG, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLINTON DOUGLAS HOLDER M.D. (OWNER)
(941) 845-4572
Entity
Organization
Contact information
Practice address
4604 29TH ST E, PALMETTO, FL 34221-9793
(941) 845-4572
(941) 845-4572
Mailing address
4604 29TH ST E, PALMETTO, FL 34221-9793
(941) 845-4572
(941) 845-4572
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263649200
—
FL
01
—
34252
BLUE CROSS/BLUE SHIELD FL
FL
01
—
5600211
GHI
—
01
—
CB6866
RAILROAD MEDICARE
—
Enumeration date
07/09/2006
Last updated
01/24/2014
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