Healthcare Provider Details

I. General information

NPI: 1528235678
Provider Name (Legal Business Name): DUDAK & DUDAK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 GLADES RD SUITE 101
BOCA RATON FL
33434-3988
US

IV. Provider business mailing address

9325 GLADES RD SUITE 101
BOCA RATON FL
33434-3988
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-8111
  • Fax: 561-451-1768
Mailing address:
  • Phone: 561-482-8111
  • Fax: 561-451-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number72788
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number64623
License Number StateFL

VIII. Authorized Official

Name: DR. SCOTT DAVID DUDAK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-482-8111