Donald P. Dudley, M.D.
Individual provider Active NPI Emergency Medicine Physician · Sonora, CA
NPI 1497727952 · NPPES record last updated Mar 23, 2009
Key facts
- NPI
- 1497727952
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- G042440 (CA)
- Practice address
- 1000 Greenley Rd
Sonora, CA 95370-5200 - Phone
- (209) 536-3460
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081217000184 | CA | Practitioner - Emergency Medicine | 7911069489 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G042440 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sierra Emergency Medical Group Inc. | Emergency Medicine | Current |
Accepting new patients |
| Sonora Community Hospital | Current | Accepting new patients |
Locations
23 N Main St
Angels Camp, CA 95222
Phone (209) 736-9130
1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803
14540 State Highway 108
Sonora, CA 95370
Phone (209) 532-3167
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | G042440 | CA | Yes |
Addresses
Primary practice location
1000 Greenley Rd
Sonora, CA 95370-5200
Mailing address
23198 Hardscrabble CT
Sonora, CA 95370-8535
Phone (209) 586-9200
Other providers in Sonora, CA
- Douglas W Ankrom, MD, Inc
- Carla Iwata Doyle
- Breeanna Duarte
- Daniel Thomas Dubose
- Tresa Irene Duckworth
- Jill Yvonne Dudley
- Roger Savage Duke
- Brainard Andrew Duncan
- Cassandra Dunlap
- Ellen Dunn
All providers in Sonora, CA · Emergency Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.