Provider Demographics
NPI:1184248809
Name:TUDURI, DAVID RAPHAEL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAPHAEL
Last Name:TUDURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2311
Mailing Address - Country:US
Mailing Address - Phone:859-433-3973
Mailing Address - Fax:
Practice Address - Street 1:1822 COURTLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2311
Practice Address - Country:US
Practice Address - Phone:859-433-3973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer