MEDICARE: DR. ELIZABETH EMBURY DUDNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	MD0000049056	TN
3	207L00000X	Anesthesiology Physician	073115	GA
4	207L00000X	Anesthesiology Physician	122474	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205153491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH EMBURY DUDNEY M.D.

Provider Business Mailing Address
First Line	:	205 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-2750
Country	:	US
Telephone Number	:	727-565-0740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	10/07/2015

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