MEDICARE: DR. DAVID B UDALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	45537	CO
2	207Q00000X	Family Medicine Physician	M4971	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UD45537	OTHER	CO	BLUE CROSS

General Provider Information

NPI Number	:	1013123165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID B UDALL MD

Provider Business Mailing Address
First Line	:	2101 MAIN ST
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3024
Country	:	US
Telephone Number	:	325-446-3305
Fax Number	:	325-446-2257

Provider Business Practice Location Address
First Line	:	109 REID RD
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3008
Country	:	US
Telephone Number	:	325-446-3305
Fax Number	:	325-446-2257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	01/21/2011

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Directions to “ DR. DAVID B UDALL MD” Practice Location

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