MEDICARE: JEFFREY MUDD 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	208000000X	Pediatrics Physician	30516	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518952480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MUDD MD

Provider Business Mailing Address
First Line	:	2605 KENTUCKY AVE
Second Line	:	DRS BLDG 3 SUITE 501
City	:	PADUCAH
State	:	KY
Zip	:	42003-3800
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 KENTUCKY AVE
Second Line	:	DRS BLDG 3 SUITE 501
City	:	PADUCAH
State	:	KY
Zip	:	42003-3800
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-0834

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	12/06/2020

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Directions to “ JEFFREY MUDD MD” Practice Location

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