DOMINIQUE MESIDOR MD P.A. (NPI# 1720113558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720113558 |
| Entity Type | Organization |
| Organization Name | DOMINIQUE MESIDOR MD P.A. |
| Practice Address |
1839 Central Ave St Petersburg FL 33713-8900 |
| Mailing Address |
Po Box 16226 St Petersburg FL 33733-6226 |
| Practice Telephone | 7278961300 |
| Practice Fax Number | 7278961311 |
| Mailing Telephone | 7278961300 |
| Mailing Fax Number | 7278961311 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2008-02-26 |
| Authorized Official Name | DOMINIQUE MESIDOR (PRESIDENT) |
| Authorized Official Telephone | 7273287400 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0127X |
Surgery Specialization: Trauma Surgery |
ME86398 | FL | Allopathic & Osteopathic Physicians |
| Y | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
ME86398 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE SHIELD FLORIDA | 37818 | 01 |
| FL | MEDICARE | U1254X | 01 |
| Street Address |
1839 CENTRAL AVE |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33713-8900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407857089 | Jeffrey Allan Gelber | Internal Medicine | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2005-08-09 |
| 1447878129 | Ericka Hering Spottke | Registered Nurse | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2020-07-09 |
| 1629695002 | Olta Plunkett | Nurse Practitioner | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2020-07-01 |
| 1780219998 | Kathleen Kay Davis | Nurse Practitioner | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2020-03-08 |
| 1336773662 | Rebecca Anderson | Pharmacist | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2020-02-25 |
| 1144868753 | Cory M Burns | Family Medicine | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2019-12-13 |
| 1154968337 | Charles M Solla | Nurse Practitioner | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2019-12-05 |
| 1346895000 | Vicki Cross | Nurse Practitioner | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2019-08-08 |
| 1679137863 | Alisha L Grimmage | Nurse Practitioner | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2019-04-24 |
| 1619434354 | Ereny Sawirs | Pharmacist | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2019-03-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073122230 | Busy Bee Aba Therapy LLC | Assistant Behavior Analyst | 441 33rd Street North #407, St. Petersburg, FL 33713 | 2020-07-23 |
| 1902428899 | Taylor Lorraine Fowler | Behavior Technician | 7381 114th Ave, Suite 405 Largo Fl 33773, Suite 405, St. Petersburg, FL 33713 | 2020-05-13 |
| 1770120180 | Mai Family and Sedation Dentistry, Pa | Dentist | 495 31st Street North, St. Petersburg, FL 33713 | 2019-12-04 |
| 1932672524 | Julie Marlowe Gilbert | Dermatology | 2191 9th Ave North, Ste. 100, St. Petersburg, FL 33713 | 2019-01-07 |
| 1962992024 | Lauren Elizabeth Oloughlin | Nurse Practitioner | 1001 37th St N Ste C, St Petersburg, FL 33713 | 2018-05-15 |
| 1447766316 | Melanie Marie Byrne | Assistant Behavior Analyst | 5185 45th St N, Bldg C, St. Petersburg, FL 33713 | 2017-12-14 |
| 1942679683 | Teresa E Peak | Physician Assistant | 2191 9th Ave N St 220, St. Petersburg, FL 33713 | 2015-09-23 |
| 1639555204 | Priya Panara | Internal Medicine | 2299 9th Ave N Ste 1f, St Petersburg, FL 33713 | 2015-08-06 |
| 1730568635 | Kevin Michael Carbonell | Dentist | 3863 Central Avenue, Saint Petersburg, FL 33713 | 2015-05-26 |
| 1558752972 | Sage Program, LLC | Community/Behavioral Health | 3530 1st Avenue North, Suite 111, St. Petersbrug, FL 33713 | 2015-02-06 |
| Find all providers in zip 33713 | ||||
| Taxonomy Code | 2086S0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Critical Care |
| A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467657890 | Khaled Basiouny | Surgery | 603 7th St S Ste 500, St Petersburg, FL 33701-4734 | 2007-06-16 |
| 1275755027 | Raquel Gonzalez | Surgery | 601 5th St S Ste 306, St Petersburg, FL 33701-4804 | 2007-05-02 |
| 1518975911 | David W Kays | Surgery | 601 5th St S, St Petersburg, FL 33701-4804 | 2006-08-03 |
| 1760445621 | Steven Stone Schumacher | Surgery | 603 7th St S, Suite 500, St Petersburg, FL 33701-4719 | 2006-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437579489 | Brandon Masi Parker | Surgery | 1611 Nw 12th Ave # 215, Miami, FL 33136-1005 | 2014-04-17 |
| 1508203100 | Kathleen Relihan | Surgery | 77 W Underwood St Ste 200, Orlando, FL 32806-1122 | 2013-05-23 |
| 1992998934 | Vivek Vijay Tirmal | Surgery | 607 Ne 11th Ave, Fort Lauderdale, FL 33304-4695 | 2007-08-23 |
| 1417028614 | Derek Powell Brock | Surgery | 836 Lakeside Dr, North Palm Beach, FL 33408-3810 | 2006-11-11 |
| 1548278856 | Patrick Gonzalez Jr. | Surgery | 12651 N Dale Mabry Hwy, #272204, Tampa, FL 33688-9001 | 2006-08-03 |
| 1124061346 | Dana A. Taylor | Surgery | 1234 Se Magnolia Ext Unit 1, Ocala, FL 34471-3778 | 2006-06-14 |
| 1730163643 | Joseph Mcginn | Surgery | 8950 N Kendall Dr Ste 607w, Miami, FL 33176-2139 | 2005-12-05 |
| 1902429475 | Giovanni Jose Flumeri-perez | Surgery | 1431 Sw 1st Ave Bldg Suite7, Ocala, FL 34471-6500 | 2020-05-19 |
| 1194384297 | Jorge A. Vega Jr., M.d., Pllc | Surgery | 3375 Burns Rd Ste 206, Palm Beach Gardens, FL 33410-4361 | 2019-06-12 |
| 1831648492 | Mario Rueda Md Pllc | Surgery | 3375 Burns Rd, Palm Beach Gardens, FL 33410-4349 | 2016-09-23 |
| Find all providers with the same taxonomy | ||||
| City | ST PETERSBURG |
| Zip Code | 33713 |
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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.