Individual
DR. LUBY A SIDOFF III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 7TH AVE N, ST PETERSBURG, FL 33705-1300
(727) 825-1100
Mailing address
PO BOX 919379, ORLANDO, FL 32891-9379
(844) 453-1406
(772) 621-3180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD15058
RI
2085R0202X
Diagnostic Radiology Physician
Primary
ME136201
FL
2085R0204X
Vascular & Interventional Radiology Physician
MD15058
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025169800
—
FL
01
—
EYGWG
FL BCBS
FL
01
—
LN359
FL MEDICARE PTAN
FL
01
—
P02532303
FL RAILROAD MEDICARE PTAN
FL
Enumeration date
06/14/2013
Last updated
08/03/2021
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