Healthcare Provider Details

I. General information

NPI: 1063453470
Provider Name (Legal Business Name): RUDOLPH MICHAEL TOVAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET RM. C-358
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

232 E BELL CT
LEXINGTON KY
40508-1935
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-2321
  • Fax: 859-257-9089
Mailing address:
  • Phone: 859-312-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40221
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number40221
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: