Provider Demographics
NPI:1265972103
Name:HEALTHY BODIES MEDICAL CENTER
Entity type:Organization
Organization Name:HEALTHY BODIES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WATSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-540-5005
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-0484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3415 BROOK CROSSING DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8181
Practice Address - Country:US
Practice Address - Phone:813-540-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-25
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11874261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center