Provider Demographics
NPI:1578555918
Name:YUDELMAN, PAUL L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:YUDELMAN
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 1:12318 MCGREGOR WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2440
Mailing Address - Country:US
Mailing Address - Phone:239-209-0669
Mailing Address - Fax:
Practice Address - Street 1:12318 MCGREGOR WOODS CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2440
Practice Address - Country:US
Practice Address - Phone:239-209-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059823207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11927WOtherMEDICARE
FLK7665OtherMEDICARE GROUP
FLP00232932OtherRR MEDICARE
FL052480800Medicaid
FL11927WOtherMEDICARE