Healthcare Provider Details

I. General information

NPI: 1659380517
Provider Name (Legal Business Name): RAYMOND F. HUDANICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAYMOND F. HUDANICH PA

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 W SUNRISE BLVD SUITE 110
PLANTATION FL
33313-6066
US

IV. Provider business mailing address

9420 N.W. 10 ST.
PLANTATION FL
33322
US

V. Phone/Fax

Practice location:
  • Phone: 954-316-1140
  • Fax: 954-316-8259
Mailing address:
  • Phone: 954-475-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME13658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: