1518023977 NPI number — DR. JAMES LEE DUDLEY D.C.

Table of content: DR. JAMES LEE DUDLEY D.C. (NPI 1518023977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518023977 NPI number — DR. JAMES LEE DUDLEY D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUDLEY
Provider First Name:
JAMES
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518023977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2851 N TENAYA WAY
Provider Second Line Business Mailing Address:
#103
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-0435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-309-4878
Provider Business Mailing Address Fax Number:
702-309-4879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N GREEN VALLEY PKWY
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-0410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-798-7171
Provider Business Practice Location Address Fax Number:
702-436-6561
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  B 373 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: V106773 . This is a "PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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