Healthcare Provider Details

I. General information

NPI: 1942372198
Provider Name (Legal Business Name): CHRISTOPHER CLAY LUDLOW PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 AIRPARK DR SUITE 301
REDDING CA
96001-2449
US

IV. Provider business mailing address

3400 DATA DR PHYSICIAN SUPPORT SERVICES - 2ND FL
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-3500
  • Fax: 530-242-3546
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA17530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: