Provider Demographics
NPI:1831139351
Name:DUDAK, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DUDAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3907
Practice Address - Country:US
Practice Address - Phone:561-482-8887
Practice Address - Fax:561-451-1768
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT138590208800000X
FL64623208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225484OtherAVMED
FLP970896OtherOPTIMUM
FL5439647OtherAETNA
FLP1010627OtherFREEDOM
FL1026039OtherCAREPLUS
FL28385OtherWELLCARE
FL45095OtherBCBS
FLP01601030OtherRR MEDICARE
FLP01601030OtherRR MEDICARE
FLP1010627OtherFREEDOM
FLG63237Medicare UPIN