Provider Demographics
NPI:1811256324
Name:DAVIDIUK, ANDREW JEREMY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JEREMY
Last Name:DAVIDIUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1134
Mailing Address - Country:US
Mailing Address - Phone:877-876-3627
Mailing Address - Fax:321-843-4101
Practice Address - Street 1:32 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1134
Practice Address - Country:US
Practice Address - Phone:877-876-3627
Practice Address - Fax:321-843-4101
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117179208800000X
FLFD4112582208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017958700Medicaid