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NPI Code Detail

MEDICARE: DR. JAMES R RUDD SR. M.D.

MEDICARE: DR. JAMES R RUDD SR. 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
1207V00000XObstetrics & Gynecology Physician15081LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750388856
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES R RUDD SR. M.D.
Provider Business Mailing Address
First Line : 206 W 5TH ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-4856
Country : US
Telephone Number : 337-463-5582
Fax Number : 337-460-1348
Provider Business Practice Location Address
First Line : 206 W 5TH ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-4856
Country : US
Telephone Number : 337-463-5582
Fax Number : 337-460-1348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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