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General NPI Number Information
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NPI Number | 1346608536
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Entity Type | Organization
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Legal Business Name | FORMULA WELLNESS PLLC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4342 LOVERS LN
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City | DALLAS
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State | TX
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Zip | 75225-6921
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Country | US
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Telephone | 214-931-9443
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Fax | 214-602-2017
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Provider Business Mailing Address
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Address Line | 4342 LOVERS LN
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City | DALLAS
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State | TX
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Zip | 75225-6921
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Country | US
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Telephone | 214-931-9443
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Fax | 214-602-2017
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. BRIAN RUDMAN
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Credential | M.D.
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Telephone | 214-931-9443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | K1038
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K1038
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License Number State | TX
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