Provider Demographics
NPI:1124086210
Name:HARRY, UDENE (EUDENE) KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:UDENE (EUDENE)
Middle Name:KATHRYN
Last Name:HARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EUDENE
Other - Middle Name:KATHRYN
Other - Last Name:HARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5979 VINELAND RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7800
Mailing Address - Country:US
Mailing Address - Phone:407-354-0500
Mailing Address - Fax:407-354-0675
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-354-0500
Practice Address - Fax:407-354-0675
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76171207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG35610Medicare UPIN