Individual
MR. DARRELL J LUDDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1072 N LIBERTY ST, SUITE 100, BOISE, ID 83704-8708
(208) 367-4321
(208) 367-4525
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M3180
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010159518
BLUE SHIELD
ID
05
—
003801000
—
ID
01
—
B5711
BLUE CROSS
ID
Enumeration date
05/20/2006
Last updated
06/19/2013
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