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General NPI Number Information
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NPI Number | 1306931423
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Entity Type | Organization
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Legal Business Name | IRON BRIDGE DIABETES & ENDO
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 1135 E LAKEWOOD ST SUITE 104
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2403
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Country | US
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Telephone | 417-879-6364
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Fax | 417-879-6368
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Provider Business Mailing Address
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Address Line | 1135 E LAKEWOOD ST SUITE 104
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2403
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Country | US
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Telephone | 417-879-6364
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Fax | 417-879-6368
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Authorized Official
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Title or Position | OWNER
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Name | DR. RALPH J DUDA JR.
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Credential | MD
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Telephone | 417-879-6364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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