Provider Demographics
NPI:1356320592
Name:DUDLEY, HEATHER L (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1658 ST VINCENTS WAY STE 130
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8459
Mailing Address - Country:US
Mailing Address - Phone:904-264-1628
Mailing Address - Fax:904-264-8386
Practice Address - Street 1:1658 ST VINCENTS WAY STE 130
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8459
Practice Address - Country:US
Practice Address - Phone:904-264-1628
Practice Address - Fax:904-264-8386
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113156207V00000X
FLOS14575207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1356320592OtherNPI
K48548Medicare PIN