Individual
MR. JUSTIN DAVID DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-5062
Mailing address
1 UNIVERSITY OF NEW MEXICO # 116025, ALBUQUERQUE, NM 87131-0001
(505) 272-5560
(505) 272-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2018-0003
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2018-0003
NM STATE LICENSE
NM
Enumeration date
05/19/2016
Last updated
03/30/2021
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