Healthcare Provider Details

I. General information

NPI: 1609030063
Provider Name (Legal Business Name): JOSHUA DAVID RUDD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BRETTWOOD TRCE
CLYDE NC
28721-8021
US

IV. Provider business mailing address

40 BRETTWOOD TRCE
CLYDE NC
28721-8021
US

V. Phone/Fax

Practice location:
  • Phone: 828-456-8633
  • Fax: 828-452-2792
Mailing address:
  • Phone: 828-452-5042
  • Fax: 828-452-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2010-00864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: