Healthcare Provider Details

I. General information

NPI: 1144242173
Provider Name (Legal Business Name): COURTNEY RELYEA DUDLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY DALE RELYEA MD

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 N MO PAC EXPY STE A
AUSTIN TX
78758-2910
US

IV. Provider business mailing address

12174 N MO PAC EXPY STE A
AUSTIN TX
78758-2910
US

V. Phone/Fax

Practice location:
  • Phone: 512-833-7334
  • Fax: 512-833-7333
Mailing address:
  • Phone: 512-833-7334
  • Fax: 512-833-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: