Individual
BLAIR KAICHEN DUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2704 N TENAYA WAY, LAS VEGAS, NV 89128-0424
(702) 243-8500
(702) 869-5347
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 579-3298
(702) 667-4689
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
7316
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063414761
—
NV
01
—
V114364
SSMA MEDICARE
NV
Enumeration date
08/11/2005
Last updated
09/01/2016
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