Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 60418 | MN |
N | 208600000X | Surgeon | 60418 | MN |
Y | 2086S0129X | Vascular Surgeon | 02005581A | IN |
N | 2086S0129X | Vascular Surgeon | 60418 | MN |
NPI | 1053515429 |
---|---|
Provider Name | Duangnapa S. Cuddy |
First Address | Bloomington, IN 47403-3239 |
Second Address | Bloomington, IN 47403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2903 | WV LICENSE (01) | WV |