MEDICARE: PERRY MARC DWORKIN D.O.

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
1	2085R0202X	Diagnostic Radiology Physician	OS 2522	FL

General Provider Information

NPI Number	:	1245237338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY MARC DWORKIN D.O.

Provider Business Mailing Address
First Line	:	277 DOUGLAS AVE STE 1014
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3321
Country	:	US
Telephone Number	:	407-788-2888
Fax Number	:	407-215-0168

Provider Business Practice Location Address
First Line	:	7208 W SAND LAKE RD
Second Line	:	SUITES 102 & 303
City	:	ORLANDO
State	:	FL
Zip	:	32819-5200
Country	:	US
Telephone Number	:	407-210-0210
Fax Number	:	407-210-0220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/19/2007

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