Provider Demographics
NPI:1710901145
Name:GIUDICE-TELLER, ROBERTA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:GIUDICE-TELLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4249
Mailing Address - Country:US
Mailing Address - Phone:352-372-3474
Mailing Address - Fax:352-372-1252
Practice Address - Street 1:1010 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4249
Practice Address - Country:US
Practice Address - Phone:352-372-3474
Practice Address - Fax:352-372-1252
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0001675213ES0131X
FLPO1675213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87907OtherBLUE CROSS
FL2135812OtherATENA
FL480005976OtherRAILROAD MEDICARE
FL030093OtherAVMED
FL3900754-00Medicaid
FL87907Medicare ID - Type Unspecified
FL030093OtherAVMED
FL480005976OtherRAILROAD MEDICARE
FLT55599Medicare UPIN