Provider Demographics
NPI:1639746043
Name:LUDEMAN, DANIEL JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:LUDEMAN
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 1:4784 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2488
Mailing Address - Country:US
Mailing Address - Phone:714-928-9642
Mailing Address - Fax:
Practice Address - Street 1:1013 W BUFFALO ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9701
Practice Address - Country:US
Practice Address - Phone:714-928-9642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant