Healthcare Provider Details

I. General information

NPI: 1306140108
Provider Name (Legal Business Name): TERRY JOHN RUDOLPH JR. ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RIVER RD
LAFAYETTE LA
70501-7700
US

IV. Provider business mailing address

220 RIVER RD
LAFAYETTE LA
70501-7700
US

V. Phone/Fax

Practice location:
  • Phone: 337-366-7887
  • Fax:
Mailing address:
  • Phone: 337-366-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: