Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 9501133 | NC |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D0066926 | MD |
NPI | 1053370536 |
---|---|
Provider Name | Dr. Gene Guy Tudor |
First Address | Prince Frederick, MD 20678 |
Second Address | Prince Frederick, MD 20678-4019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 02/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83936 | BCBS (01) | NC |
8983936 | (05) | NC |
9501133 | STATE LICENSE (01) | NC |
BT1769794 | DEA (01) | NC |
D0066926 | MD STATE LICENSE (01) | MD |
E31316 | (02) | NC |