Healthcare Provider Details

I. General information

NPI: 1356436406
Provider Name (Legal Business Name): RALPH J DUDA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E REPUBLIC RD STE D200
SPRINGFIELD MO
65807-6012
US

IV. Provider business mailing address

909 E REPUBLIC RD STE D200
SPRINGFIELD MO
65807-6012
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-7889
  • Fax: 417-890-6151
Mailing address:
  • Phone: 417-883-7889
  • Fax: 417-890-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR7G82
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: