Provider Demographics
NPI:1679796460
Name:JOHN T. DUDDY M.D. PC
Entity type:Organization
Organization Name:JOHN T. DUDDY M.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-278-8141
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:STE C305
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-278-8141
Mailing Address - Fax:907-279-3527
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:STE C305
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-278-8141
Practice Address - Fax:907-279-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG018Medicaid
AKMD1419Medicaid
AKMDG018Medicaid
AKK151692Medicare ID - Type Unspecified