Healthcare Provider Details

I. General information

NPI: 1902117732
Provider Name (Legal Business Name): CLARE ELIZABETH RUDOLPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARE E RUDOLPH FRANZ MD

II. Dates (important events)

Enumeration Date: 06/26/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 3RD ST
SOUTH LAKE TAHOE CA
96150-3465
US

IV. Provider business mailing address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

V. Phone/Fax

Practice location:
  • Phone: 530-543-5711
  • Fax: 530-578-3712
Mailing address:
  • Phone: 530-543-5659
  • Fax: 530-541-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20907
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA124647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: