Provider Demographics
NPI:1356436406
Name:DUDA, RALPH J JR (MD)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:J
Last Name:DUDA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:909 E REPUBLIC RD STE D200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6012
Mailing Address - Country:US
Mailing Address - Phone:417-883-7889
Mailing Address - Fax:417-890-6151
Practice Address - Street 1:909 E REPUBLIC RD STE D200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6012
Practice Address - Country:US
Practice Address - Phone:417-883-7889
Practice Address - Fax:417-890-6151
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7G82207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00266673OtherPTAN
MO16610OtherBLUE CROSS BLUE SHIELD
MO16610OtherBLUE CROSS BLUE SHIELD
MOA12144Medicare UPIN