Provider Demographics
NPI:1801063961
Name:DOUKIDES, THEODORE PANO (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:PANO
Last Name:DOUKIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:951 NW 13TH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2337
Mailing Address - Country:US
Mailing Address - Phone:561-368-3455
Mailing Address - Fax:561-368-8642
Practice Address - Street 1:951 NW 13TH ST STE 2E
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-368-3455
Practice Address - Fax:561-368-8642
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000741000Medicaid
FL000741000Medicaid