Individual provider Active NPI

Marla Weissler Dudak, M.D.

  • Surgical Oncology Physician
  • Salt Lake City, UT
National Provider Identifier
1154359529
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
License
13143314-1205 Issued in UT
Practice address
1220 E 3900 S Ste 4I
Salt Lake City, UT 84124-1383
Phone
(801) 948-2380
NPI assigned
Jun 28, 2006
Last updated
Mar 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X ME72788 FL
Surgical Oncology Physician 2086X0206X ME72788 FL
Surgical Oncology Physician 2086X0206X 13143314-1205 UT Primary

Addresses

Primary practice location

1220 E 3900 S Ste 4I
Salt Lake City, UT 84124-1383

Mailing address

3702 Aspen PT
Park City, UT 84098-4912
Phone (561) 706-0234

Other identifiers 9

IdentifierTypeStateIssuer
7507281OtherFLAETNA
P975925OtherFLOPTIMUM
P01601033OtherFLRR MEDICARE
1035777OtherFLCAREPLUS
3080244OtherFLCIGNA
330975OtherFLWELLCARE
280120OtherFLAVMED
P1041371OtherFLFREEDOM
05071OtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240802002133 UT Practitioner - General Surgery 2163486812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Duke University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1220 E 3900
Suite 4I
Salt Lake City, UT 84124-1383
Phone (801) 948-2380

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME72788FLMDSurgery Physician
13143314-1205UTMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesiscare USA of Florida LLC Surgery Current Accepting new patients
Marla W Dudak MD PC Surgery CurrentSince Apr 10, 2024 Accepting new patients
Genesiscare USA of Florida LLC CurrentSince Jan 11, 2016 Accepting new patients
Genesiscare USA of Florida LLC CurrentSince Jan 11, 2016 Accepting new patients
Genesiscare USA of Florida LLC Past Accepting new patients

Locations

9325 Glades Rd
Ste 101
Boca Raton, FL 33434
Phone (561) 482-8111

1419 SE 8th Ter
Cape Coral, FL 33990
Phone (239) 772-3202

2160 Colonial Blvd
Fort Myers, FL 33907

2234 Colonial Blvd
Fort Myers, FL 33907
Phone (239) 931-7212

730 Goodlette Rd
Ste 201
Naples, FL 34102
Phone (239) 262-1119

3343 S State Road 7
Wellington, FL 33449
Phone (561) 795-8945

1220 E 3900 S
Ste 4I
Salt Lake Cty, UT 84124
Phone (801) 263-1621

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BIGEDD/Endpoint/BIGEDD

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1154359529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 ASPEN PT",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840984912",
            "telephone_number": "561-706-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 E 3900 S STE 4I",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241383",
            "telephone_number": "801-948-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDAK",
        "first_name": "MARLA",
        "middle_name": "WEISSLER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME72788",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "FL",
            "license": "ME72788",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "UT",
            "license": "13143314-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7507281",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM",
            "identifier": "P975925",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01601033",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREPLUS",
            "identifier": "1035777",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3080244",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "330975",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "280120",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM",
            "identifier": "P1041371",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "05071",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.