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NPI Code Detail

MEDICARE: DR. BRIAN DAVID UDELL M.D.

MEDICARE: DR. BRIAN DAVID UDELL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME 42264FL

General Provider Information

NPI Number : 1073779724
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN DAVID UDELL M.D.
Provider Business Mailing Address
First Line : 6974 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4345
Country : US
Telephone Number : 954-873-8413
Fax Number : 954-792-2424
Provider Business Practice Location Address
First Line : 6974 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4345
Country : US
Telephone Number : 954-873-8413
Fax Number : 954-792-2424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2008
Last Update Date : 05/19/2021

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