MEDICARE: DR. ROBERT HARRIS DUDLEY 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	207Q00000X	Family Medicine Physician	ME79702	FL

General Provider Information

NPI Number	:	1619973328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT HARRIS DUDLEY MD

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	# 204
City	:	GREENACRES
State	:	FL
Zip	:	33463-4727
Country	:	US
Telephone Number	:	561-968-7968
Fax Number	:	561-964-4603

Provider Business Practice Location Address
First Line	:	2645 N FEDERAL HWY
Second Line	:	# 100
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6128
Country	:	US
Telephone Number	:	561-740-2004
Fax Number	:	561-742-8226

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/31/2016

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