Provider Demographics
NPI:1992779292
Name:TUDER, DMITRY (MD)
Entity type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:TUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 ROGERS XING STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4776
Mailing Address - Country:US
Mailing Address - Phone:210-598-5605
Mailing Address - Fax:210-598-5620
Practice Address - Street 1:10010 ROGERS XING STE 308
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4776
Practice Address - Country:US
Practice Address - Phone:210-598-5605
Practice Address - Fax:210-598-5620
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0952207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212285505Medicaid
TX257866YXAJMedicare PIN