Provider Demographics
NPI:1265733430
Name:FRANCISCO G TUDELA M.D PA
Entity type:Organization
Organization Name:FRANCISCO G TUDELA M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:G
Authorized Official - Last Name:TUDELA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-691-1171
Mailing Address - Street 1:777 E 25TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3804
Mailing Address - Country:US
Mailing Address - Phone:305-691-1171
Mailing Address - Fax:305-693-6726
Practice Address - Street 1:777 E 25TH ST STE 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3804
Practice Address - Country:US
Practice Address - Phone:305-691-1171
Practice Address - Fax:305-693-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36365174400000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1190HILHOtherNHP
FL95746OtherBCBS ID #
FL058554800Medicaid
FL209384OtherAVMED
FL95746OtherBCBS ID #
FLD65851Medicare UPIN