Provider Demographics
NPI:1215982988
Name:DAN T TUDOR MD PL
Entity type:Organization
Organization Name:DAN T TUDOR MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TUDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-323-5047
Mailing Address - Street 1:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-1881
Mailing Address - Country:US
Mailing Address - Phone:407-323-5047
Mailing Address - Fax:407-323-5048
Practice Address - Street 1:419 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1407
Practice Address - Country:US
Practice Address - Phone:407-323-5047
Practice Address - Fax:407-323-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94020207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0456Medicare PIN