Healthcare Provider Details

I. General information

NPI: 1316976913
Provider Name (Legal Business Name): PAUL LOUIS LUDMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 HAWTHORNE AVE #201
OAKLAND CA
94609-3107
US

IV. Provider business mailing address

365 HAWTHORNE AVE #201
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-452-1345
  • Fax: 510-452-1102
Mailing address:
  • Phone: 510-452-1345
  • Fax: 510-452-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG46760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG46760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: