Provider Demographics
NPI:1164558672
Name:RAYMOND F HUDANICH MD PA
Entity Type:Organization
Organization Name:RAYMOND F HUDANICH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HUDANICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-316-1140
Mailing Address - Street 1:6710 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6066
Mailing Address - Country:US
Mailing Address - Phone:954-316-1140
Mailing Address - Fax:954-316-8259
Practice Address - Street 1:6710 W SUNRISE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6066
Practice Address - Country:US
Practice Address - Phone:954-316-1140
Practice Address - Fax:954-316-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13658207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0986293OtherCIGNA
FL06869OtherBCBS
D51750Medicare UPIN
FL06869VMedicare ID - Type Unspecified