Individual
DERON LUDWIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W BROADWAY ST FL 5, MISSOULA, MT 59802-4008
(406) 329-5866
(406) 329-5864
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
C52097
CA
208600000X
Surgery Physician
Primary
MED-PHYS-LIC-124231
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C520970
MEDICARE NUMBER
CA
Enumeration date
10/16/2006
Last updated
06/15/2023
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