Provider Demographics
NPI:1548525611
Name:DUDLEY, MATTHEW THOMAS (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE STE M917
Mailing Address - Street 2:BOX 0624
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0624
Mailing Address - Country:US
Mailing Address - Phone:415-514-3781
Mailing Address - Fax:415-514-0185
Practice Address - Street 1:505 PARNASSUS AVE STE M917
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0624
Practice Address - Country:US
Practice Address - Phone:415-514-3781
Practice Address - Fax:415-514-0185
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3201001683146L00000X
CAA131338207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine