Provider Demographics
NPI:1154408920
Name:LUDWIG, PHILIP JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1589 SPARTA ST
Mailing Address - Street 2:STE 106
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110
Mailing Address - Country:US
Mailing Address - Phone:931-815-4580
Mailing Address - Fax:931-815-4583
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:STE 106
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-815-4580
Practice Address - Fax:931-815-4583
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01753OtherNC STATE LICENSE
NC33660OtherBCBS NC
NC8933660Medicaid
NC01753OtherNC STATE LICENSE
NC33660OtherBCBS NC