Provider Demographics
NPI:1932514247
Name:DUDGEON, JANAE (MD)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:DUDGEON
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:PO BOX N
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0518
Mailing Address - Country:US
Mailing Address - Phone:402-269-2611
Mailing Address - Fax:402-483-5079
Practice Address - Street 1:2731 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-7880
Practice Address - Country:US
Practice Address - Phone:402-269-2611
Practice Address - Fax:402-483-5079
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP7252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine