Provider Demographics
NPI:1124343876
Name:P. DUDLEY GILES, MD, PA
Entity type:Organization
Organization Name:P. DUDLEY GILES, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:P.
Authorized Official - Middle Name:DUDLEY
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-546-3223
Mailing Address - Street 1:323 SE OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2227
Mailing Address - Country:US
Mailing Address - Phone:772-546-3223
Mailing Address - Fax:772-220-1168
Practice Address - Street 1:323 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2227
Practice Address - Country:US
Practice Address - Phone:772-546-3223
Practice Address - Fax:772-220-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083459208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57715OtherBLUE CROSS BLUE SHIELD
FLP00039155OtherRAILROAD MEDICARE
FL57715OtherBLUE CROSS BLUE SHIELD
FLE8702Medicare PIN