Provider Demographics
NPI:1831120492
Name:LUDWIG, IRENE H (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:H
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ROSS CLARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301
Mailing Address - Country:US
Mailing Address - Phone:334-793-2211
Mailing Address - Fax:334-793-7161
Practice Address - Street 1:2800 ROSS CLARK CIRCLE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-793-2211
Practice Address - Fax:334-793-7161
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016158207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000046550Medicaid
AL051510558Medicaid
AL3858168OtherCIGNA GOVERNMENT
AL515-43647OtherBCBS
AL51518368OtherBCBS
AL515-10558OtherBCBS
AL515-44656OtherBCBS
ALB83168OtherVIVA
AL5188015OtherAETNA
AL51046550OtherBCBS
ALP00102920OtherRAILROAD MEDICARE
AL000046550Medicaid
AL051554260Medicare PIN
AL051510558Medicaid