Provider Demographics
NPI:1245237338
Name:DWORKIN, PERRY MARC (DO)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:MARC
Last Name:DWORKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 DOUGLAS AVE STE 1014
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3321
Mailing Address - Country:US
Mailing Address - Phone:407-788-2888
Mailing Address - Fax:407-215-0168
Practice Address - Street 1:7208 W SAND LAKE RD
Practice Address - Street 2:SUITES 102 & 303
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5200
Practice Address - Country:US
Practice Address - Phone:407-210-0210
Practice Address - Fax:407-210-0220
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 25222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81802DMedicare PIN