Individual
BEVERLY J LUDDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5966 CURTISIAN AVE, BOISE, ID 83704-8801
(208) 375-8100
(208) 373-2643
Mailing address
5966 CURTISIAN AVE, BOISE, ID 83704-8801
(208) 375-8100
(208) 373-2643
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3179
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005367
BLUE SHIELD
ID
01
—
31799
BLUE CROSS
ID
Enumeration date
06/06/2006
Last updated
07/08/2007
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