Provider Demographics
NPI:1609001106
Name:DOCTOR, TRUDELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:TRUDELL
Middle Name:A
Last Name:DOCTOR
Suffix:
Gender:F
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:PO BOX 810501
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33481-0501
Mailing Address - Country:US
Mailing Address - Phone:561-866-3200
Mailing Address - Fax:
Practice Address - Street 1:6080 BOYNTON BEACH BLVD STE 230
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3588
Practice Address - Country:US
Practice Address - Phone:561-807-7780
Practice Address - Fax:866-950-0144
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103551207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCD627ZMedicare PIN