Provider Demographics
NPI:1790399566
Name:DUDLEY, RICHIE (PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:RICHIE
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 W YELLOWJACKET LN APT 805
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4834
Mailing Address - Country:US
Mailing Address - Phone:469-809-0520
Mailing Address - Fax:
Practice Address - Street 1:931 W YELLOWJACKET LN APT 805
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4834
Practice Address - Country:US
Practice Address - Phone:469-809-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157780146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty