Organization
FAMILY MEDICINE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL EDWARD DUDLEY I M.D. (PRESIDENT)
(712) 423-1525
Entity
Organization
Contact information
Practice address
1614 DIAMOND STREET PL, ONAWA, IA 51040-1554
(712) 423-1525
(712) 423-2528
Mailing address
1614 DIAMOND STREET PL, ONAWA, IA 51040-1554
(712) 423-1525
(712) 423-2528
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0638312
—
IA
01
—
63831
BLUE SHIELD
IA
01
—
CQ2293
RAILROAD MEDICARE
IA
Enumeration date
06/24/2005
Last updated
07/21/2022
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