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General NPI Number Information
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NPI Number | 1316958622
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Entity Type | Individual
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Provider Name | KEITH RUEDE P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 1315 HOSPITAL DR
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-9210
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Country | US
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Telephone | 802-748-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 HOSPITAL DR PO BOX 905
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-9210
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Country | US
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Telephone | 802-748-8141
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 055-0030218
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License Number State | VT
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