Healthcare Provider Details

I. General information

NPI: 1164496360
Provider Name (Legal Business Name): PAUL DUDLEY GILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/05/2008
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:
Title or Position:
Credential:
Phone: