Healthcare Provider Details

I. General information

NPI: 1639814759
Provider Name (Legal Business Name): DANIEL PATRICK LUDEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 455 BOX 208
FPO AP
96540-0003
US

IV. Provider business mailing address

PSC 455 BOX 208
FPO AP
96540-0003
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101279603
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: