Provider Demographics
NPI:1508990151
Name:DUDLEY, JOHN W (HEARING AID DEPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:HEARING AID DEPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3922
Mailing Address - Country:US
Mailing Address - Phone:361-991-5360
Mailing Address - Fax:361-980-8361
Practice Address - Street 1:6040 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3922
Practice Address - Country:US
Practice Address - Phone:361-991-5360
Practice Address - Fax:361-980-8361
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50314237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508990151Medicaid