Provider Demographics
NPI:1912974585
Name:MUDAFORT, ERIC SARKIS (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SARKIS
Last Name:MUDAFORT
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:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0474
Mailing Address - Country:US
Mailing Address - Phone:941-962-9791
Mailing Address - Fax:
Practice Address - Street 1:1020 34TH DR W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-2553
Practice Address - Country:US
Practice Address - Phone:941-962-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56921207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00017940OtherRAILROAD
FL00448OtherUNIVERSAL MEDICARE MASTERPIECE
FL191910OtherAMERIGROUP
FL836514OtherUNITED HEALTHCARE
FL10311OtherBCBS
FL202561OtherWELLCARE
FL260804900Medicaid
FLP102210OtherFREEDOM HEALTH
FL836514OtherUNITED HEALTHCARE
FL836514OtherUNITED HEALTHCARE
FLP102210OtherFREEDOM HEALTH