Provider Demographics
NPI:1396915674
Name:DR. GREGG LUDWIG DPM PC
Entity type:Organization
Organization Name:DR. GREGG LUDWIG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:970-359-3838
Mailing Address - Street 1:2901 MAIN AVE
Mailing Address - Street 2:SIUTE B
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4242
Mailing Address - Country:US
Mailing Address - Phone:970-259-3838
Mailing Address - Fax:970-247-3074
Practice Address - Street 1:2901 MAIN AVE
Practice Address - Street 2:SIUTE B
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4242
Practice Address - Country:US
Practice Address - Phone:970-259-3838
Practice Address - Fax:970-247-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO344261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003441Medicaid
CO01003441Medicaid