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General NPI Number Information
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NPI Number | 1639124779
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Entity Type | Individual
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Provider Name | AVIDAH H RUDBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 9500 BONITA BEACH RD SE STE 201
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4683
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Country | US
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Telephone | 239-441-2932
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Fax | 239-441-4045
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Provider Business Mailing Address
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Address Line | 6321 DANIELS PKWY STE 200
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City | FORT MYERS
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State | FL
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Zip | 33912-4710
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Country | US
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Telephone | 239-416-8101
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Fax | 239-402-8601
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME142399
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License Number State | FL
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