Provider Demographics
NPI:1184631491
Name:DRESDNER, DAVID MARK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:DRESDNER
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 1:1099 5TH AVE NORTH
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705
Mailing Address - Country:US
Mailing Address - Phone:727-820-7714
Mailing Address - Fax:727-820-7755
Practice Address - Street 1:1099 5TH AVE NORTH
Practice Address - Street 2:SUITE 120
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705
Practice Address - Country:US
Practice Address - Phone:727-820-7714
Practice Address - Fax:727-820-7755
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME034572207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57342Medicare UPIN
62198BMedicare ID - Type Unspecified