Provider Demographics
NPI:1841318771
Name:DUDLEY, JULIE H (DO)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:H
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2902 LITTLE JOHN DR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1666
Mailing Address - Country:US
Mailing Address - Phone:580-677-1537
Mailing Address - Fax:
Practice Address - Street 1:1600 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3045
Practice Address - Country:US
Practice Address - Phone:580-924-5500
Practice Address - Fax:580-924-1991
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH27105Medicare UPIN