Provider Demographics
NPI:1649413907
Name:CUDERMAN, BART STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:STANLEY
Last Name:CUDERMAN
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 1:14640 DOUBLE EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1716
Mailing Address - Country:US
Mailing Address - Phone:239-561-6488
Mailing Address - Fax:
Practice Address - Street 1:14640 DOUBLE EAGLE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1716
Practice Address - Country:US
Practice Address - Phone:239-561-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16936208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery