Provider Demographics
NPI:1609878826
Name:CUDDY, GARY D (PA-C)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:CUDDY
Suffix:
Gender:M
Credentials:PA-C
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 270
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0270
Mailing Address - Country:US
Mailing Address - Phone:402-336-2901
Mailing Address - Fax:402-336-2961
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1519
Practice Address - Country:US
Practice Address - Phone:402-336-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3863OtherMIDLANDS CHOICE
NE7909019OtherAETNA
NE0123939OtherMEDICA
NE460423930OtherTRICARE
NE9238079OtherDAKOTA CARE
NE37387OtherNEBRASKA BCBS
NE460423930OtherHUMANA
NE46042393011Medicaid
NE460423930OtherTRICARE
NE270819Medicare PIN
NE37387OtherNEBRASKA BCBS
NER81932Medicare UPIN