Provider Demographics
NPI:1639672579
Name:MUDD, JAMIE D (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:D
Last Name:MUDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5402
Mailing Address - Country:US
Mailing Address - Phone:859-341-1011
Mailing Address - Fax:859-341-7198
Practice Address - Street 1:20 MEDICAL VILLAGE DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5402
Practice Address - Country:US
Practice Address - Phone:859-341-1011
Practice Address - Fax:859-341-7198
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY57756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics