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General NPI Number Information
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NPI Number | 1154277390
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Entity Type | Individual
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Provider Name | JOHN DAVID RUD
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Gender | Male
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 1400 E WASILLA SHOPS CIR
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City | WASILLA
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State | AK
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Zip | 99654-8306
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Country | US
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Telephone | 907-268-4686
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Fax |
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Provider Business Mailing Address
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Address Line | 18600 SE MCLOUGHLIN BLVD
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City | MILWAUKIE
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State | OR
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Zip | 97267-6723
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Country | US
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Telephone | 503-946-3267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | AK
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