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General NPI Number Information
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NPI Number | 1942482088
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Entity Type | Individual
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Provider Name | MICHAEL DAVID RUDD PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 4402 93RD DR
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City | LUBBOCK
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State | TX
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Zip | 79424-5106
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Country | US
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Telephone | 806-786-0680
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Fax | 806-742-0818
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Provider Business Mailing Address
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Address Line | 4402 93RD DR
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City | LUBBOCK
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State | TX
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Zip | 79424-5106
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Country | US
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Telephone | 806-786-0680
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Fax | 806-742-0818
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23874
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License Number State | TX
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