Healthcare Provider Details

I. General information

NPI: 1710398656
Provider Name (Legal Business Name): RYAN PERDZOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 110
NAPLES FL
34102-5886
US

IV. Provider business mailing address

1223 WHIPPOORWILL LN
NAPLES FL
34105-5028
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8490
  • Fax: 239-624-8491
Mailing address:
  • Phone: 239-304-1600
  • Fax: 239-280-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME132085
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN# 19961
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME132085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: