Provider Demographics
NPI:1164496360
Name:GILES, PAUL DUDLEY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DUDLEY
Last Name:GILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083459208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57715OtherBLUE CROSS BLUE SHIELD
FLE8702Medicare PIN
FLF30825Medicare UPIN
FLP00039155Medicare PIN