Basic Information
| Provider Information | |||||||||
| NPI: | 1437156650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUDGE | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 LOWER RAGSDALE DR | ||||||||
| Address2: | 100 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316247070 | ||||||||
| FaxNumber: | 8316247050 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 LOWER RAGSDALE DR | ||||||||
| Address2: | 100 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316247070 | ||||||||
| FaxNumber: | 8316247050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G76261 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.