Provider Demographics
NPI:1568600104
Name:MAYOZ, RUDY (MD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:
Last Name:MAYOZ
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 1:16206 HOYLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2875
Mailing Address - Country:US
Mailing Address - Phone:813-926-9282
Mailing Address - Fax:
Practice Address - Street 1:16206 HOYLAKE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2875
Practice Address - Country:US
Practice Address - Phone:813-926-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07244Medicare UPIN