Provider Demographics
NPI:1740463496
Name:RICARDO BUDJAK MD PA
Entity type:Organization
Organization Name:RICARDO BUDJAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDJAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-389-3581
Mailing Address - Street 1:2574 HERSCHEL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4556
Mailing Address - Country:US
Mailing Address - Phone:904-389-3581
Mailing Address - Fax:
Practice Address - Street 1:2574 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4556
Practice Address - Country:US
Practice Address - Phone:904-389-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLET069AMedicare PIN
GA110221628Medicare PIN