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General NPI Number Information
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NPI Number | 1962606293
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Entity Type | Individual
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Provider Name | JAMES DUDLEY A.T.C. LICENSED
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1405 N 4TH AVE PMB 4166
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City | DURANT
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State | OK
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Zip | 74701-3330
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Country | US
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Telephone | 580-745-3028
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Fax | 580-745-7493
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Provider Business Mailing Address
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Address Line | 94 EAGLE LOOP DRIVE
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City | DURANT
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State | OK
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Zip | 74701-0609
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Country | US
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Telephone | 580-924-2124
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Fax | 580-745-7493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 414
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License Number State | OK
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