MEDICARE: ROBERT C UDELL D.O.

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	207R00000X	Internal Medicine Physician	OS7144	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952375560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C UDELL D.O.

Provider Business Mailing Address
First Line	:	PO BOX 741268
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-1268
Country	:	US
Telephone Number	:	321-452-3811
Fax Number	:	321-454-4026

Provider Business Practice Location Address
First Line	:	1980 N ATLANTIC AVE
Second Line	:	SUITE 1010
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-5213
Country	:	US
Telephone Number	:	321-868-0902
Fax Number	:	321-799-4968

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/30/2012

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Directions to “ ROBERT C UDELL D.O.” Practice Location

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