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General NPI Number Information
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NPI Number | 1033541875
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Entity Type | Organization
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Legal Business Name | TIMOTHY J. RUDDELL, M.D., PLLC
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Dates
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Enumeration Date | 08/03/2013
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Last Update Date | 08/03/2013
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Provider Practice Location Address
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Address Line | 600 E TAYLOR ST STE 201
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City | SHERMAN
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State | TX
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Zip | 75090-2832
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Country | US
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Telephone | 903-957-1104
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E TAYLOR ST STE 201
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City | SHERMAN
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State | TX
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Zip | 75090-2832
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Country | US
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Telephone | 903-957-1104
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TIMOTHY J. RUDDELL
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Credential | M.D.
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Telephone | 903-957-1104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | P7029
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License Number State | TX
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