Active NPI
Calvin Dudley, M.D.
- Colon & Rectal Surgery Physician
- Albuquerque, NM
National Provider Identifier
1972524619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Colon & Rectal Surgery Physician
- License
- 86-222
- Practice address
- 3810 Masthead St NE
Albuquerque, NM 87109-4479 - Phone
- (505) 243-3514
- Fax
- (505) 243-3451
- NPI assigned
- Jul 21, 2006
- 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 |
|---|---|---|---|---|
| Colon & Rectal Surgery Physician | 208C00000X | 86-222 | NM | Primary |
Addresses
Primary practice location
3810 Masthead St NE
Albuquerque, NM 87109-4479
Mailing address
3810 Masthead St NE
Albuquerque, NM 87109-4479
Phone (505) 243-3514
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM010744 | Other | NM | BCBS NEW MEXICO |
| 201002646 | Other | NM | PRESBYTERIAN HEALTH PLAN |
| 37689 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86-222 | NM | MD | Colon & Rectal Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234137600000",
"number": "1972524619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3810 MASTHEAD ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094479",
"telephone_number": "505-243-3514",
"fax_number": "505-243-3451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3810 MASTHEAD ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094479",
"telephone_number": "505-243-3514",
"fax_number": "505-243-3451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDLEY",
"first_name": "CALVIN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2009-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "208C00000X",
"taxonomy_group": "",
"desc": "Colon & Rectal Surgery",
"state": "NM",
"license": "86-222",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NEW MEXICO",
"identifier": "NM010744",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN HEALTH PLAN",
"identifier": "201002646",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37689",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.