Provider Demographics
NPI:1982603056
Name:DRUKMAN, SUSAN JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOY
Last Name:DRUKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5090
Mailing Address - Country:US
Mailing Address - Phone:407-380-0201
Mailing Address - Fax:407-380-0301
Practice Address - Street 1:11325 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5090
Practice Address - Country:US
Practice Address - Phone:407-380-0201
Practice Address - Fax:407-380-0301
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56999207QG0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10729OtherBLUE CROSS BLUE SHIELD
FL10729OtherBLUE CROSS BLUE SHIELD
FL10729WMedicare PIN
FLE53006Medicare UPIN
FL10729VMedicare PIN