Healthcare Provider Details

I. General information

NPI: 1427398296
Provider Name (Legal Business Name): RUDY F SCHMIEDECKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-2050
US

IV. Provider business mailing address

2050 BARB ST
SILVERDALE WA
98315
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9660
  • Fax: 619-532-9458
Mailing address:
  • Phone: 360-315-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberA132164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA123164
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA132164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: