Individual
JEFFREY MUDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2605 KENTUCKY AVE, DRS BLDG 3 SUITE 501, PADUCAH, KY 42003-3800
(270) 744-9600
(270) 744-0834
Mailing address
2605 KENTUCKY AVE, DRS BLDG 3 SUITE 501, PADUCAH, KY 42003-3800
(270) 744-9600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
30516
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64305162
—
KY
Enumeration date
09/15/2005
Last updated
12/06/2020
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