Provider Demographics
NPI:1629192455
Name:JOHN J. DUDEK JR. M.D. PC
Entity Type:Organization
Organization Name:JOHN J. DUDEK JR. M.D. PC
Other - Org Name:ACCREDITED UROLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DUDEK JR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-7055
Mailing Address - Street 1:2020 GOLDRING AVE
Mailing Address - Street 2:506
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4060
Mailing Address - Country:US
Mailing Address - Phone:702-382-7055
Mailing Address - Fax:702-382-9935
Practice Address - Street 1:2020 GOLDRING AVE
Practice Address - Street 2:506
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4060
Practice Address - Country:US
Practice Address - Phone:702-382-7055
Practice Address - Fax:702-382-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC95987Medicare UPIN