DR. JOHN KENNETH DUDEK (NPI# 1235216706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235216706 |
| Entity Type | Individual |
| Full Name | DR. JOHN KENNETH DUDEK |
| Credential | M.D. |
| Practice Address |
500 W Fort St Medical Services Boise ID 83702-4501 |
| Practice Telephone | 2084221325 |
| Practice Fax Number | 2084221319 |
| Mailing Telephone | 2084221325 |
| Mailing Fax Number | 2084221319 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
21562 | AZ | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144267782 | John Joseph Dudek | Dentist | 6970 Smoke Ranch Rd, Suite 150, Las Vegas, NV 89128 | 2006-06-01 |
| 1316904055 | John Joseph Dudek Jr. | Registered Nurse | 2020 Goldring Ave, #506, Las Vegas, NV 89106-4060 | 2006-04-27 |
| Street Address |
500 W FORT ST MEDICAL SERVICES |
| City | BOISE |
| State | ID |
| Zip Code | 83702-4501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063411007 | Sandra Gee Jue | Pharmacist | 500 W Fort St, Bldg 44a, Boise, ID 83702-4501 | 2005-07-20 |
| 1952902389 | Christine Alice Walsh | Recreation Therapist | 500 W Fort St, Boise, ID 83702-4501 | 2020-11-03 |
| 1386243160 | Elizabeth Larsen | Registered Nurse | 500 W Fort St, Boise, ID 83702-4598 | 2020-10-22 |
| 1013516293 | Rebecca Cotterell | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-10-20 |
| 1487253670 | Morgan Wussow | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-10-20 |
| 1548867435 | Justin Hyer | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-10-05 |
| 1881209336 | Daniel James Councell | Physician Assistant | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-11 |
| 1508470451 | Marcus J Day | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-08 |
| 1386258291 | Vanessa Potoski | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-08 |
| 1033723788 | Brian Lynn Lambrecht | Licensed Practical Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255399820 | Warren William Gude | Emergency Medicine | 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 | 2006-05-03 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1801818182 | Barton Hill | Emergency Medicine | 190 E Bannock St, Boise, ID 83712-6241 | 2006-07-24 |
| 1598703902 | J Thomas Ahlquist | Emergency Medicine | 190 E Bannock St, Boise, ID 83712-6241 | 2006-06-04 |
| 1437109253 | Christopher Gnadinger | Emergency Medicine | 190 E Bannock St, Boise, ID 83712-6241 | 2006-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538516471 | Anthony Christopher Derrico | Emergency Medicine | 366 Gunfighter Ave Ste 498, Mountain Home Afb, ID 83648-5258 | 2016-05-20 |
| 1881752913 | Richard K Thurston | Emergency Medicine | 229 S 7th Street, St Maries, ID 83861 | 2006-12-04 |
| 1841679669 | Robert John Hagenberg IIi | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642 | 2015-05-26 |
| 1194019406 | Michael Anderson | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2011-06-03 |
| 1508003104 | Rocky Mountain Emergency Physicians, LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201 | 2009-01-19 |
| 1225201148 | Rodney Gillman Jay Jr. | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-04-11 |
| 1720114275 | North Idaho Immediate Care | Emergency Medicine | 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 | 2007-02-26 |
| 1407903669 | Debra K Mckinnon | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1710034988 | Kurt R Martyn | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1093891954 | Dawn Rachelle Gertson | Emergency Medicine | 2003 Kootenai Health Way, Hospital Specialists-kmc Kootenai Medical Ctr, Coeur D Alene, ID 83814 | 2006-10-31 |
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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.