Organization
INFECTIOUS DISEASE CONSULTANTS OF ST. PETERSBURG, P.A.
Active
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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