MEDICARE: R CLAUDIO DMD MD PA

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	15004	FL

General Provider Information

NPI Number	:	1902830227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R CLAUDIO DMD MD PA

Provider Business Mailing Address
First Line	:	2720 PARK DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763
Country	:	US
Telephone Number	:	727-726-8500
Fax Number	:	727-725-9716

Provider Business Practice Location Address
First Line	:	2720 PARK DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763
Country	:	US
Telephone Number	:	727-726-8500
Fax Number	:	727-725-9716

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. RICHELE E RAND GREEN
Credential	:
Telephone Number	:	727-726-8500

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/16/2007

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