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Individual
JOHN A DUDLEY
Active
Individual
JOHN A DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5164
AZ
390200000X
Student in an Organized Health Care Education/Training Program
5164
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
749101
—
AZ
Enumeration date
09/25/2012
Last updated
02/18/2014
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