MEDICARE: DR. JAMES GORDON ROUDEBUSH 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	2083A0100X	Aerospace Medicine Physician	14432	NE

General Provider Information

NPI Number	:	1649265216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GORDON ROUDEBUSH M.D.

Provider Business Mailing Address
First Line	:	4778 COMMAND LN
Second Line	:
City	:	ANDREWS AIR FORCE BASE
State	:	MD
Zip	:	20762-5568
Country	:	US
Telephone Number	:	301-599-0266
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LUKE AVE
Second Line	:	SUITE 400
City	:	BOLLING AIR FORCE BASE
State	:	DC
Zip	:	20032-7050
Country	:	US
Telephone Number	:	202-767-4766
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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