Provider Demographics
NPI:1790938199
Name:DUDDER, JAMES R (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:DUDDER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 NE 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4412
Mailing Address - Country:US
Mailing Address - Phone:503-819-9302
Mailing Address - Fax:
Practice Address - Street 1:4445 SW BARBUR BLVD
Practice Address - Street 2:STE 104
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4047
Practice Address - Country:US
Practice Address - Phone:503-226-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist