Healthcare Provider Details

I. General information

NPI: 1528072246
Provider Name (Legal Business Name): DAVID WALTER RUDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

138 LEADER AVE
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5981
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax: 859-257-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33426
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number33426
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number33426
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: