| Organization Name: | CRAIG DEPODESTA, DO, PA |
| NPI Number: | 1649537754 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRIAG R DEPODESTA (OWNER) |
| Mailing Address: | 231b Commercial Blvd Lauderdale By The Sea |
| State: | FL US |
| Postal Code: | 333084441 |
| Phone Number: | 9545301600 |
| Fax Number: | 9543068234 |
| NPI Enumeration Date: | 04/13/2012 |
| NPI Last Update Date: | 08/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS8042 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |