Provider Demographics
NPI:1578604658
Name:DUDLEY, SCOTT ANDREW
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ANDREW
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WENSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3839
Mailing Address - Country:US
Mailing Address - Phone:760-352-8840
Mailing Address - Fax:
Practice Address - Street 1:1295 W STATE ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2845
Practice Address - Country:US
Practice Address - Phone:760-337-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program