Provider Demographics
NPI:1477728640
Name:FUDGE, JAMES CURTIS JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CURTIS
Last Name:FUDGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CURT
Other - Middle Name:
Other - Last Name:FUDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:UNIVERSITY OF FLORIDA COM
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-273-5422
Mailing Address - Fax:352-392-0547
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:THE CONGENITAL HEART CENTER AT UF
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610
Practice Address - Country:US
Practice Address - Phone:352-273-5422
Practice Address - Fax:352-392-0547
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-010122080P0202X
FLME107837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149CCOtherBCBSFL
GA003110304AMedicaid
FL002668600Medicaid
FL149CCOtherBCBSFL
FL002668600Medicaid