DR. RANDALL G. DUDIK (NPI# 1154487700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154487700 |
| Entity Type | Individual |
| Full Name | DR. RANDALL G. DUDIK |
| Credential | MD |
| Practice Address |
1100 W 10th St Suite 160 Rolla MO 65401-2937 |
| Mailing Address |
Po Box 2580 Springfield MO 65801-2580 |
| Practice Telephone | 5733413043 |
| Practice Fax Number | 5733415208 |
| Mailing Telephone | 4178294620 |
| Mailing Fax Number | 4178294316 |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2008-07-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | R7G68 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 208534107 | 05 |
| Street Address |
1100 W 10TH ST SUITE 160 |
| City | ROLLA |
| State | MO |
| Zip Code | 65401-2937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053564674 | Mercy Hospital Springfield | Durable Medical Equipment & Medical Supplies | 1100 W 10th St, Suite 150, Rolla, MO 65401-2937 | 2008-10-28 |
| 1942347190 | Vera Mikhailova | Pediatrics | 1100 W 10th St, Suite 175, Rolla, MO 65401-2937 | 2007-01-30 |
| 1700923943 | Sean A. Mcenaney | Pediatrics | 1100 W 10th St, Suite 175, Rolla, MO 65401-2937 | 2007-01-30 |
| 1144379736 | Jerry E. Thomas | Family Medicine | 1100 W 10th St, Suite 200, Rolla, MO 65401-2937 | 2007-01-10 |
| 1326197997 | James F. Mccaul | Obstetrics & Gynecology | 1100 W 10th St, Suite 140, Rolla, MO 65401-2937 | 2007-01-10 |
| 1194881748 | Luther D. Spurlock | Family Medicine | 1100 W 10th St, Suite 160, Rolla, MO 65401-2937 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639645591 | Samantha Jo Mitchell | Pharmacist | 1375 E 10th St Suite B, Rolla, MO 65401 | 2018-10-18 |
| 1427567726 | Gerry Wade Funkhouser Jr. | Counselor | 103 W 10th St, Rolla, MO 65401 | 2017-09-29 |
| 1366967960 | Shana Hintz Wisniewski | Social Worker | 1000 W. 10th St., Rolla, MO 65401 | 2017-08-04 |
| 1174066559 | Tabitha Hundt | Counselor | 1011 Cypress Dr, Rolla, MO 65401 | 2016-12-02 |
| 1841742855 | Alpha Assisted Living LLC | Assisted Living Facility | 13450 Cr 7040, 803 E 12th St, Rolla, MO 65401 | 2016-10-26 |
| 1275916884 | Elizabeth Zersen | Occupational Therapist | 2053 Vienna Rd, Rolla, MO 65401 | 2015-06-30 |
| 1386047025 | Becky L Witham | Nurse Practitioner | 1060 W 10th Street, Rolla, MO 65401 | 2014-10-08 |
| 1114326121 | Summer Adey | Licensed Practical Nurse | 13750 State Route F, Rolla, MO 65401 | 2014-08-14 |
| 1518303296 | Leaetta Mildred Gardner | Nursing Facility/Intermediate Care Facility | 13450 County Road 7040, Rolla, MO 65401 | 2013-05-21 |
| 1316282064 | Susan Peitz Gruener | Occupational Therapy Assistant | 1800 White Column Road, Rolla, MO 65401 | 2012-12-06 |
| Find all providers in zip 65401 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477791606 | Matthew Timothy Porter | Family Medicine | 831 Laurel Dr, Rolla, MO 65401-3841 | 2009-01-26 |
| 1104028489 | Goodman Medical Center PC | Family Medicine | 715 State Route Cc, Rolla, MO 65401-4402 | 2007-05-31 |
| 1811028723 | Mercy Clinic-springfield Communities | Family Medicine | 1605 Martin Springs Dr Ste 210, Rolla, MO 65401-3028 | 2007-03-09 |
| 1609912443 | Allen E. Northern | Family Medicine | 1601 N Bishop Ave, Rolla, MO 65401-2249 | 2007-01-29 |
| 1295801926 | Kessinger Diagnostic Centre | Family Medicine | 411 Us Hwy 72 E, Rolla, MO 65401 | 2006-11-27 |
| 1760564637 | Stephanie Nicole Huhn | Family Medicine | 1605 Martin Springs Dr Ste 230, Rolla, MO 65401-2980 | 2006-10-20 |
| 1891724902 | Duane D Glasner | Family Medicine | 114 Ne 3rd St, Rolla, NC 58367-0699 | 2006-07-01 |
| 1396717104 | Kimberly D. Johnson | Family Medicine | 1081 E 18th St, Rolla, MO 65401-2448 | 2006-02-06 |
| 1548232440 | William David Myers | Family Medicine | 1218 E State Route 72, Rolla, MO 65401-3938 | 2006-02-03 |
| 1255867479 | South Central Missouri Community Health Center | Family Medicine | 200 N Main St, Suite 51g, Rolla, MO 65401-3061 | 2017-05-09 |
| Find all providers in ROLLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.