Provider Demographics
NPI:1104883610
Name:DUDA, VINCENT RUDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:RUDOLPH
Last Name:DUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3277
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:30281 GOLDEN LANTERN
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5979
Practice Address - Country:US
Practice Address - Phone:949-495-7144
Practice Address - Fax:949-495-0270
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB209530Medicare PIN
CAP01391233OtherRR MEDICARE
W13226LOtherPROVIDER #
CAA47641Medicare UPIN
G38938OtherSTATE LICENSE