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1912122276 NPI number — WINSTON EARL RUDDER PAC

NPI Number: 1912122276
Health Care Provider/Practitioner: WINSTON EARL RUDDER PAC

Information about “1912122276” NPI (WINSTON EARL RUDDER PAC) exists in 1912122276 in HTML format HTML  |  1912122276 in plain Text format TXT  |  1912122276 in PDF (Portable Document Format) PDF  |  1912122276 in an XML format XML  formats.

NPI Number : 1912122276 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912122276",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUDDER",
    "FirstName": "WINSTON",
    "MiddleName": "EARL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6186 ADOBE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "29 PALMS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92277-2652",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-361-8525",
    "MailingAddressFaxNumber": "760-361-8528",
    "FirstLinePracticeLocationAddress": "6186 ADOBE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "29 PALMS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92277-2652",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-361-8525",
    "PracticeLocationAddressFaxNumber": "760-361-8528",
    "EnumerationDate": "04/13/2007",
    "LastUpdateDate": "01/15/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA15830",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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