Healthcare Provider Details

I. General information

NPI: 1043216500
Provider Name (Legal Business Name): PAUL C LUDLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY STE 509
RENO NV
89502-1469
US

IV. Provider business mailing address

59 DAMONTE RANCH PKWY # B557
RENO NV
89521-1907
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-3800
  • Fax:
Mailing address:
  • Phone: 775-324-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number3496
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: