Provider Demographics
NPI:1720051451
Name:DUDLEY, GAIL J (DO)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:J
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8411
Mailing Address - Country:US
Mailing Address - Phone:352-669-3161
Mailing Address - Fax:
Practice Address - Street 1:287 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8411
Practice Address - Country:US
Practice Address - Phone:352-669-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S5327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E32322Medicare UPIN
FL82965VMedicare ID - Type Unspecified