Provider Demographics
NPI:1922084094
Name:LUDT, WILLIAM C (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:LUDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-396-1360
Mailing Address - Fax:520-795-9043
Practice Address - Street 1:4892 N STONE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5761
Practice Address - Country:US
Practice Address - Phone:520-396-1360
Practice Address - Fax:520-795-9043
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224957Medicaid
105248Medicare ID - Type Unspecified
C98276Medicare UPIN