Provider Demographics
NPI:1679642409
Name:RAUDENBUSH, DOREEN M (DPM)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:RAUDENBUSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SW 34TH CIRCLE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-861-0444
Mailing Address - Fax:352-861-0464
Practice Address - Street 1:3301 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-861-0444
Practice Address - Fax:352-861-0464
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00003075213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97014Medicare UPIN
U14232Medicare ID - Type Unspecified