MEDICARE: ELLEN FRANCES DUDREY 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	207ZC0500X	Cytopathology Physician	G3309	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G3309	TX

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	:	1578524567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN FRANCES DUDREY MD

Provider Business Mailing Address
First Line	:	PO BOX 740968
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75374-0968
Country	:	US
Telephone Number	:	915-521-1341
Fax Number	:	915-521-1494

Provider Business Practice Location Address
First Line	:	1801 NORTH OREGON STREET
Second Line	:	DEPARTMENT OF PATHOLOGY
City	:	EL PASO
State	:	TX
Zip	:	79902-3591
Country	:	US
Telephone Number	:	915-521-1341
Fax Number	:	915-521-1494

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	12/17/2007

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