Provider Demographics
NPI:1134209810
Name:HADDOCK, DAVID GENE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GENE
Last Name:HADDOCK
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 1:10345 ORANGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8239
Mailing Address - Country:US
Mailing Address - Phone:407-352-6900
Mailing Address - Fax:407-352-6163
Practice Address - Street 1:10345 ORANGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8239
Practice Address - Country:US
Practice Address - Phone:407-352-6900
Practice Address - Fax:407-352-6163
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059965208100000X
OH67120208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
0666956OtherAETNA HMO QPOS PROVIDER #
12237XOtherBLUE CROSS BLUE SHIELD PR
593224058001OtherPRUCARE PROVIDER #
6421534009OtherCIGNA PROVIDER #
FL054222900Medicaid
4205668OtherAETNA PPO POS PROVIDER #
6421534009OtherCIGNA PROVIDER #