Healthcare Provider Details

I. General information

NPI: 1902913312
Provider Name (Legal Business Name): ALAN T RUDOLPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CATTLEMEN RD STE 100
SARASOTA FL
34232
US

IV. Provider business mailing address

PO BOX 978743
DALLAS TX
75397-8743
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-5884
  • Fax: 844-876-0873
Mailing address:
  • Phone: 317-614-9863
  • Fax: 844-876-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME21545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: