Provider Demographics
NPI:1386650414
Name:DUDDY, ROBERT KELSO (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KELSO
Last Name:DUDDY
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:PO BOX 419074
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9074
Mailing Address - Country:US
Mailing Address - Phone:314-432-1903
Mailing Address - Fax:314-432-5105
Practice Address - Street 1:11709 OLD BALLAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7029
Practice Address - Country:US
Practice Address - Phone:314-432-1903
Practice Address - Fax:314-432-5105
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO000512213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT70965Medicare UPIN