Basic Information
| Provider Information | |||||||||
| NPI: | 1801063961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUKIDES | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | PANO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 NW 13TH ST STE 2E | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613683455 | ||||||||
| FaxNumber: | 5613688642 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 NW 13TH ST STE 2E | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613683455 | ||||||||
| FaxNumber: | 5613688642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2008 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME101501 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000741000 | 05 | FL | MEDICAID |