MEDICARE: ROBERT ERDMAN, D.D.S.,P.A.

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	122300000X	Dentist	11444	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	598094	OTHER		UNITED CONCORDIA
2	63042	OTHER	FL	BLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number	:	1922343102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT ERDMAN, D.D.S.,P.A.

Provider Business Mailing Address
First Line	:	2578 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9124
Country	:	US
Telephone Number	:	386-775-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	2578 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9124
Country	:	US
Telephone Number	:	386-775-1552
Fax Number	:

Authorized Official
Title or Position	:	INSURANCECOORDINATOR
Name	:	ILENE PAWLIK
Credential	:
Telephone Number	:	386-775-1552

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	11/29/2012

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