Provider Demographics
NPI:1003019019
Name:DUDNEY, BLONIE WAYNE JR (MD)
Entity Type:Individual
Prefix:
First Name:BLONIE
Middle Name:WAYNE
Last Name:DUDNEY
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:3011
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-839-1211
Mailing Address - Fax:314-839-8429
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:3011
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-839-1211
Practice Address - Fax:314-839-8429
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010014075207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO131420001Medicare PIN