Provider Demographics
NPI:1003840539
Name:DUDDLESTON, DAVID NEWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NEWELL
Last Name:DUDDLESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CHADWYCK PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6508
Mailing Address - Country:US
Mailing Address - Phone:601-291-1993
Mailing Address - Fax:601-321-2682
Practice Address - Street 1:128 CHADWYCK PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6508
Practice Address - Country:US
Practice Address - Phone:601-291-1993
Practice Address - Fax:601-321-2682
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10654207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015358Medicaid
MS302I114015Medicare PIN
MS110000619Medicare ID - Type Unspecified
MS00015358Medicaid