Provider Demographics
NPI:1417963448
Name:CHUDLEIGH, JAMES P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:CHUDLEIGH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 S COLORADO STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2707
Mailing Address - Country:US
Mailing Address - Phone:512-398-3936
Mailing Address - Fax:729-777-4269
Practice Address - Street 1:130 HAYS STREET
Practice Address - Street 2:SUITE B AND D
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-3207
Practice Address - Country:US
Practice Address - Phone:512-398-3936
Practice Address - Fax:726-777-4269
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2022-02-08
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Provider Licenses
StateLicense IDTaxonomies
TXF1450207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140378458Medicaid
TX140378458Medicaid
TX8E0180Medicare ID - Type Unspecified