Active NPI
David Elliott Mudge, PA
- Medical Physician Assistant
- Phoenix, AZ
National Provider Identifier
1073829818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3207
- Practice address
- 50 E Dunlap
Ste 105
Phoenix, AZ 85020 - Phone
- (602) 944-4626
- Fax
- (602) 944-2805
- NPI assigned
- Aug 30, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3207 | AZ | Primary |
Addresses
Primary practice location
50 E Dunlap
Ste 105
Phoenix, AZ 85020
Mailing address
50 E. Dunlap
Ste 105
Phoenix, AZ 85020
Phone (602) 944-4626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1073829818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 E. DUNLAP",
"address_2": "STE 105",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85020",
"telephone_number": "602-944-4626",
"fax_number": "602-944-2805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 E DUNLAP",
"address_2": "STE 105",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85020",
"telephone_number": "602-944-4626",
"fax_number": "602-944-2805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDGE",
"first_name": "DAVID",
"middle_name": "ELLIOTT",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-30",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "3207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.