Provider Demographics
NPI:1154359529
Name:DUDAK, MARLA WEISSLER (MD)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:WEISSLER
Last Name:DUDAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 ASPEN PT
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4912
Mailing Address - Country:US
Mailing Address - Phone:561-706-0234
Mailing Address - Fax:
Practice Address - Street 1:1220 E 3900 S STE 4I
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1383
Practice Address - Country:US
Practice Address - Phone:801-948-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72788208600000X, 2086X0206X
UT13143314-12052086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7507281OtherAETNA
FLP975925OtherOPTIMUM
FLP01601033OtherRR MEDICARE
FL1035777OtherCAREPLUS
FL3080244OtherCIGNA
FL330975OtherWELLCARE
FL280120OtherAVMED
FLP1041371OtherFREEDOM
FL05071OtherBCBS
FLP01601033OtherRR MEDICARE
FLP1041371OtherFREEDOM