Healthcare Provider Details

I. General information

NPI: 1326141359
Provider Name (Legal Business Name): JAMES R DUDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 PINE GROVE RD SUITE 102
STEAMBOAT SPRINGS CO
80487-8803
US

IV. Provider business mailing address

1135 E HIGHWAY 40
CRAIG CO
81625-1208
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-0203
  • Fax: 970-879-1389
Mailing address:
  • Phone: 970-824-1088
  • Fax: 970-824-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18625
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: