Provider Demographics
NPI:1659380517
Name:HUDANICH, RAYMOND F (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:F
Last Name:HUDANICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:F
Other - Last Name:HUDANICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:9420 N.W. 10 ST.
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322
Mailing Address - Country:US
Mailing Address - Phone:954-475-8873
Mailing Address - Fax:
Practice Address - Street 1:6710 W SUNRISE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6066
Practice Address - Country:US
Practice Address - Phone:954-316-1140
Practice Address - Fax:954-316-8259
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13658207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250715300Medicaid
FL550835587OtherTAX ID
FL250715300Medicaid
FLD51750Medicare UPIN