Provider Demographics
NPI:1316904055
Name:DUDEK, JOHN JOSEPH JR (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:DUDEK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 GOLDRING AVE
Mailing Address - Street 2:#506
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4060
Mailing Address - Country:US
Mailing Address - Phone:702-382-7055
Mailing Address - Fax:702-382-9935
Practice Address - Street 1:2020 GOLDRING AVE
Practice Address - Street 2:#506
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4060
Practice Address - Country:US
Practice Address - Phone:702-382-7055
Practice Address - Fax:702-382-9935
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3293163WU0100X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002008Medicaid
NV002002008Medicaid
NVVMD3293Medicare PIN