Provider Demographics
NPI:1922210582
Name:NUDELL, JUSTIN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:R
Last Name:NUDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13777 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4003
Mailing Address - Country:US
Mailing Address - Phone:727-544-1600
Mailing Address - Fax:727-546-9071
Practice Address - Street 1:13777 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4003
Practice Address - Country:US
Practice Address - Phone:727-544-1600
Practice Address - Fax:727-546-9071
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9289207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology