MEDICARE: BLAIR KAICHEN DUDDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	7316	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	V114364	OTHER	NV	SSMA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063414761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR KAICHEN DUDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	702-579-3298
Fax Number	:	702-667-4689

Provider Business Practice Location Address
First Line	:	2704 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0424
Country	:	US
Telephone Number	:	702-243-8500
Fax Number	:	702-869-5347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/01/2016

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Directions to “ BLAIR KAICHEN DUDDY MD” Practice Location

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