Provider Demographics
NPI:1457321580
Name:BUDDE, DOUGLAS R JR (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:BUDDE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6230
Mailing Address - Country:US
Mailing Address - Phone:725-220-8667
Mailing Address - Fax:833-749-0353
Practice Address - Street 1:915 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6230
Practice Address - Country:US
Practice Address - Phone:725-220-8667
Practice Address - Fax:833-749-0353
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV10543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCI7026OtherGROUP RAILROAD MEDICARE
NVP00054854OtherRAILROAD MEDICARE
NV1457321580Medicaid
NVGD340ZOtherMEDICARE PTAN
NVGD340ZOtherMEDICARE PTAN
NV1457321580Medicaid