Provider Demographics
NPI:1386704856
Name:PALANCA, EDUARDO P (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:P
Last Name:PALANCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 RIGSBY LN
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4828
Mailing Address - Country:US
Mailing Address - Phone:727-724-8777
Mailing Address - Fax:855-649-6066
Practice Address - Street 1:2901 RIGSBY LN
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4828
Practice Address - Country:US
Practice Address - Phone:727-724-8777
Practice Address - Fax:855-649-6066
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106551207Q00000X
WI42699207Q00000X
FLME 107758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149PNOtherBCBSF
FL003086500Medicaid
WI34026300Medicaid
FL149PNOtherBCBSF
H26498Medicare UPIN
FL003086500Medicaid
FLEU072XMedicare PIN
IL510420 L97988Medicare PIN