Provider Demographics
NPI:1649477357
Name:UDALL, JOHN HUNT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUNT
Last Name:UDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1432 S DOBSON
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-412-7400
Mailing Address - Fax:480-412-5991
Practice Address - Street 1:1432 S DOBSON
Practice Address - Street 2:SUITE 304
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-412-7400
Practice Address - Fax:480-412-5991
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ41972207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z131168Medicare PIN