Provider Demographics
NPI:1417585134
Name:DUDDLESTON, PATE
Entity Type:Individual
Prefix:
First Name:PATE
Middle Name:
Last Name:DUDDLESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S. ROBERTSON ST.
Mailing Address - Street 2:STE. 1300 MAIL CODE 8047
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112
Mailing Address - Country:US
Mailing Address - Phone:504-988-9134
Mailing Address - Fax:504-988-5793
Practice Address - Street 1:131 S. ROBERTSON ST.
Practice Address - Street 2:STE. 1300 MAIL CODE 8047
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-988-9134
Practice Address - Fax:504-988-5793
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program