MEDICARE: DR. JASON ROBERT DUDAS MD

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	208200000X	Plastic Surgery Physician	ME160599	FL
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A119840	CA
3	208200000X	Plastic Surgery Physician	2007016633	MO

General Provider Information

NPI Number	:	1427253244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON ROBERT DUDAS MD

Provider Business Mailing Address
First Line	:	3536 N FEDERAL HWY STE 100
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6264
Country	:	US
Telephone Number	:	954-380-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	3536 N FEDERAL HWY STE 100
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6264
Country	:	US
Telephone Number	:	954-380-8411
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	08/09/2023

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