TEODORO MEDINA (NPI# 1093852113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093852113 |
| Entity Type | Individual |
| Full Name | TEODORO MEDINA |
| Other Name | TEODORO MEDINA MONTANO |
| Credential | M.D. |
| Practice Address |
111 Webb Dr Davenport FL 33837-3962 |
| Mailing Address |
6675 Westwood Blvd Ste 475 Orlando FL 32821 |
| Practice Telephone | 8634219447 |
| Practice Fax Number | 8634211806 |
| Mailing Telephone | 4078450330 |
| Mailing Fax Number | 8889721752 |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2017-12-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | ACN 793 | FL | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 14489 | PR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FL BLUE | TW49T | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134175094 | Teodoro G Medina | Internal Medicine | 2 Chenoweth Dr Ste A, Bridgeport, WV 26330-1688 | 2006-05-25 |
| Street Address |
111 WEBB DR |
| City | DAVENPORT |
| State | FL |
| Zip Code | 33837-3962 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356321665 | Nelson Miguel Pichardo | Internal Medicine | 111 Webb Dr, Suite 2, Davenport, FL 33837 | 2006-01-20 |
| 1144510124 | Keyshla Marie Rivera Baez | General Practice | 111 Webb Dr, Davenport, FL 33837 | 2011-04-12 |
| 1336346246 | Garrovillo Surgical Care LLC | Surgery | 111 Webb Dr, Suite 3, Davenport, FL 33837-3944 | 2007-07-03 |
| 1356567788 | Juan Carlos Escandon | Family Medicine | 111 Webb Dr, Davenport, FL 33837-3962 | 2007-04-17 |
| 1447389812 | Alayne N Boland | Nurse Practitioner | 111 Webb Dr, Davenport, FL 33837-3944 | 2007-03-03 |
| 1306802905 | Charlene Edmee D'acosta | General Practice | 111 Webb Dr, Davenport, FL 33837 | 2006-04-22 |
| 1629031679 | Betania Reyes Matos | General Practice | 111 Webb Dr, Davenport, FL 33837 | 2006-04-10 |
| 1114997699 | Gilfredy Acevedo | Internal Medicine | 111 Webb Dr, Davenport, FL 33837-3962 | 2006-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922612274 | Kimberly Zariya Honaker | Massage Therapist | 398 Madison Drive, Davenport, FL 33837 | 2020-09-03 |
| 1609480375 | Sun Health and Wellness, Inc | Pharmacy | 109 Park Place Blvd, Suite A, Davenport, FL 33837 | 2020-09-01 |
| 1093323156 | Tammey Davis Payne | Counselor | 1423 Merrimack Lane, Davenport, FL 33837 | 2020-07-15 |
| 1346872835 | Shelly Hanson | Dietitian, Registered | 40100 Us 27, Davenport, FL 33837 | 2020-02-12 |
| 1689221269 | Adventist Health System /sunbelt, Inc. | Clinic/Center | 40124 Us Hwy 27, Suite 205, Davenport, FL 33837 | 2019-08-20 |
| 1578029039 | Portia P White | In Home Supportive Care | 108 East James St, Davenport, FL 33837 | 2019-02-20 |
| 1366937146 | Sheetal Kirat Parikh | Dietitian, Registered | 40100 Us Highway 27, Davenport, FL 33837 | 2018-06-25 |
| 1063929883 | Marisa Christine Sweetser | Registered Nurse | 40100 Us-27, Davenport, FL 33837 | 2018-01-02 |
| 1104341460 | Haley Kampf | Behavioral Analyst | 4303 Cortland Dr, Davenport, FL 33837 | 2017-08-08 |
| 1013438373 | Tamara Michelle Ortiz | Speech-Language Pathologist | 206 Nova Drive, Davenport, FL 33837 | 2017-06-27 |
| Find all providers in zip 33837 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013474063 | Surgeons of Central Florida LLC | General Practice | 755 Jay Bee Avenue, Davenport, FL 33897 | 2019-02-26 |
| 1902138951 | Jack Eff | General Practice | 1556 Challenger Ave, Davenport, FL 33897-6404 | 2010-02-02 |
| 1912130527 | Ismael Ruiz-de La Rosa I | General Practice | 111 Webb Dr Ste 475, Davenport, FL 33837 | 2009-08-29 |
| 1932301900 | James Richard Lucas | General Practice | 202 Broadway Ave., Davenport, OK 74026 | 2007-06-01 |
| 1366503583 | Reyna Isabel Lajara | General Practice | 127 Ridge Center Dr, Davenport, FL 33837-6401 | 2006-12-12 |
| 1265430961 | Quad City Family Physicians, PC | General Practice | 3940 N Marquette St, Davenport, IA 52806-4430 | 2005-07-07 |
| 1548681950 | Jmj3 Heritage, L.L.C. | General Practice | 3800 Commerce Blvd, Davenport, IA 52807-3495 | 2014-01-02 |
| 1144510124 | Keyshla Marie Rivera Baez | General Practice | 111 Webb Dr, Davenport, FL 33837 | 2011-04-12 |
| 1477709160 | Ladapo Shyngle | General Practice | 121 Webb Dr, Suite 100, Davenport, FL 33837-3904 | 2008-08-13 |
| 1306802905 | Charlene Edmee D'acosta | General Practice | 111 Webb Dr, Davenport, FL 33837 | 2006-04-22 |
| Find all providers in DAVENPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.