Provider Demographics
NPI:1366290686
Name:DIDORCHUK, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DIDORCHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAVLO
Other - Middle Name:
Other - Last Name:DIDORCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6325 US HIGHWAY 27 N STE 201
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8226
Mailing Address - Country:US
Mailing Address - Phone:863-402-3411
Mailing Address - Fax:
Practice Address - Street 1:6325 US HIGHWAY 27 N STE 201
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8226
Practice Address - Country:US
Practice Address - Phone:863-382-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN39640390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program