Provider Demographics
NPI:1144515404
Name:DUDLEY-ROBEY, EDWARD GILES (MD, NMD, CTTP)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GILES
Last Name:DUDLEY-ROBEY
Suffix:
Gender:M
Credentials:MD, NMD, CTTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 MILAGRO DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-6893
Mailing Address - Country:US
Mailing Address - Phone:818-943-3713
Mailing Address - Fax:
Practice Address - Street 1:5514 MILAGRO DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-6893
Practice Address - Country:US
Practice Address - Phone:818-943-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN191397164X00000X
CADSD2604174H00000X
NC400055963175F00000X
AL848175F00000X
ZZCTTP-201600262208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No175F00000XOther Service ProvidersNaturopath
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice