Provider Demographics
NPI:1710398656
Name:PERDZOCK, RYAN (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PERDZOCK
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 1:1223 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5028
Mailing Address - Country:US
Mailing Address - Phone:239-304-1600
Mailing Address - Fax:239-280-5999
Practice Address - Street 1:311 9TH ST N STE 110
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5886
Practice Address - Country:US
Practice Address - Phone:239-624-8490
Practice Address - Fax:239-624-8491
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132085207QH0002X, 207RH0002X
FLTRN# 19961390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021889600Medicaid
FL4IV89OtherBCBS