MEDICARE: DR. MERRITT C RUDOLPH MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	16397	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033171483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERRITT C RUDOLPH MD PC

Provider Business Mailing Address
First Line	:	850 E HARVARD AVE
Second Line	:	STE 405
City	:	DENVER
State	:	CO
Zip	:	80210-5077
Country	:	US
Telephone Number	:	303-722-4683
Fax Number	:	303-778-0726

Provider Business Practice Location Address
First Line	:	850 E HARVARD AVE
Second Line	:	STE 405
City	:	DENVER
State	:	CO
Zip	:	80210-5077
Country	:	US
Telephone Number	:	303-722-4683
Fax Number	:	303-778-0726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	10/26/2007

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