Provider Demographics
NPI:1912079807
Name:SCUDERI, GAETANO J (MD)
Entity Type:Individual
Prefix:DR
First Name:GAETANO
Middle Name:J
Last Name:SCUDERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2055 MILITARY TRAIL
Mailing Address - Street 2:STE 204
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-747-9334
Mailing Address - Fax:561-747-9633
Practice Address - Street 1:2055 MILITARY TRAIL
Practice Address - Street 2:STE 204
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-747-9334
Practice Address - Fax:561-747-9633
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64034207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18768VMedicare ID - Type UnspecifiedPROVIDER
FLF49835Medicare UPIN