Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME72788 | FL |
Y | 208600000X | Surgeon | ME72788 | FL |
N | 2086X0206X | Surgical Oncologist | ME72788 | FL |
NPI | 1154359529 |
---|---|
Provider Name | Dr. Marla Weissler Dudak |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Boca Raton, FL 33434-3988 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05071 | BCBS (01) | FL |
1035777 | CAREPLUS (01) | FL |
280120 | AVMED (01) | FL |
3080244 | CIGNA (01) | FL |
330975 | WELLCARE (01) | FL |
7507281 | AETNA (01) | FL |
H51809 | (02) | FL |
P01601033 | RR MEDICARE (01) | FL |
P1041371 | FREEDOM (01) | FL |
P975925 | OPTIMUM (01) | FL |