Individual
DR. RANDALL G. DUDIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 W 10TH ST, SUITE 160, ROLLA, MO 65401-2937
(573) 341-3043
(573) 341-5208
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R7G68
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208534107
—
MO
Enumeration date
12/28/2006
Last updated
07/14/2008
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