MEDICARE: GARY HOWARD DWORKIN 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME61044	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	134223953	OTHER	FL	HUMANA
2	14685	OTHER	FL	BCBS
3	998783	OTHER	FL	UNITED
4	210106	OTHER	FL	AVMED
5	19867	OTHER	FL	STAYWELL
6	0624644	OTHER	FL	AETNA
7	1888411	OTHER	FL	CIGNA
8	19867	OTHER	FL	WELLCARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851365662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY HOWARD DWORKIN MD

Provider Business Mailing Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 102
City	:	TAMPA
State	:	FL
Zip	:	33609-4130
Country	:	US
Telephone Number	:	813-374-9002
Fax Number	:	813-374-9093

Provider Business Practice Location Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 102
City	:	TAMPA
State	:	FL
Zip	:	33609-4130
Country	:	US
Telephone Number	:	813-374-9002
Fax Number	:	813-374-9093

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	09/02/2015

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Directions to “ GARY HOWARD DWORKIN MD” Practice Location

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