Healthcare Provider Details

I. General information

NPI: 1124343876
Provider Name (Legal Business Name): P. DUDLEY GILES, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 SE OSCEOLA ST
STUART FL
34994-2227
US

IV. Provider business mailing address

323 SE OSCEOLA ST
STUART FL
34994-2227
US

V. Phone/Fax

Practice location:
  • Phone: 772-546-3223
  • Fax: 772-220-1168
Mailing address:
  • Phone: 772-546-3223
  • Fax: 772-220-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0083459
License Number StateFL

VIII. Authorized Official

Name: P. DUDLEY GILES
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 772-546-3223