Organization
IRON BRIDGE DIABETES & ENDO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH J DUDA JR. MD (OWNER)
(417) 879-6364
Entity
Organization
Contact information
Practice address
1135 E LAKEWOOD ST, SUITE 104, SPRINGFIELD, MO 65810-2403
(417) 879-6364
(417) 879-6368
Mailing address
1135 E LAKEWOOD ST, SUITE 104, SPRINGFIELD, MO 65810-2403
(417) 879-6364
(417) 879-6368
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015170
MEDICARE PTAN
—
01
—
16610
BLUE CROSS BLUE SHIELD
—
01
—
460002667
PTAN
—
01
—
P00266673
RAILROAD MEDICARE PTAN
MO
Enumeration date
10/04/2006
Last updated
07/17/2008
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