Provider Demographics
NPI:1851365662
Name:DWORKIN, GARY HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:HOWARD
Last Name:DWORKIN
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 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:813-374-9002
Mailing Address - Fax:813-374-9093
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:813-374-9002
Practice Address - Fax:813-374-9093
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61044208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL134223953OtherHUMANA
FL14685OtherBCBS
FL998783OtherUNITED
FL210106OtherAVMED
FL19867OtherSTAYWELL
FL0624644OtherAETNA
FL1888411OtherCIGNA
FL19867OtherWELLCARE
FL134223953OtherHUMANA
FL998783OtherUNITED
FLP00083736Medicare PIN