Provider Demographics
NPI:1538185707
Name:TUDELA, FRANCISCO G JR (MD)
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:G
Last Name:TUDELA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:777 E 25TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3804
Mailing Address - Country:US
Mailing Address - Phone:305-691-1171
Mailing Address - Fax:844-798-8918
Practice Address - Street 1:777 E 25TH ST STE 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3804
Practice Address - Country:US
Practice Address - Phone:305-691-1171
Practice Address - Fax:844-798-8918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME36365207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL591389214OtherTAX ID
FL058554800Medicaid
FL95746YMedicaid
FL95746Medicare PIN