Individual
DR. LUBY A SIDOFF III
Active
Individual
DR. LUBY A SIDOFF III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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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