Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A24662 | CA |
NPI | 1013053727 |
---|---|
Provider Name | Milton Kenneth Mudge |
First Address | Colton, CA 92324-1801 |
Second Address | Colton, CA 92324-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 18/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24068 | (02) | CA |
ZZZ24406Z | MEDICARE LOCATION (01) | CA |