Provider Demographics
NPI:1578524567
Name:DUDREY, ELLEN FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:FRANCES
Last Name:DUDREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740968
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-0968
Mailing Address - Country:US
Mailing Address - Phone:915-521-1341
Mailing Address - Fax:915-521-1494
Practice Address - Street 1:1801 NORTH OREGON STREET
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3591
Practice Address - Country:US
Practice Address - Phone:915-521-1341
Practice Address - Fax:915-521-1494
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3309207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF5588Medicaid
E48595Medicare UPIN
TX8D3867Medicare PIN
NMF5588Medicaid