MEDICARE: DR. BEETHOVEN T RUEDAS M.D.

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	207Q00000X	Family Medicine Physician	ME29914	FL

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	:	1346247418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEETHOVEN T RUEDAS M.D.

Provider Business Mailing Address
First Line	:	4231 SNOWDON LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-1627
Country	:	US
Telephone Number	:	904-641-7082
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 BLANDING BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-8917
Country	:	US
Telephone Number	:	904-276-1133
Fax Number	:	904-276-1821

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	02/25/2010

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