MEDICARE: RUDOLF CHURNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G0591	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376528869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUDOLF CHURNER MD

Provider Business Mailing Address
First Line	:	1501 REDBUD BLVD
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3226
Country	:	US
Telephone Number	:	972-548-0771
Fax Number	:	972-562-2300

Provider Business Practice Location Address
First Line	:	1501 REDBUD BLVD
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3226
Country	:	US
Telephone Number	:	972-548-0771
Fax Number	:	972-562-2300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	03/28/2011

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