MEDICARE: MR. WALTER RUDAY JR. MSW

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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1760644009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WALTER RUDAY JR. MSW

Provider Business Mailing Address
First Line	:	2748 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2123
Country	:	US
Telephone Number	:	904-739-2242
Fax Number	:	904-739-0171

Provider Business Practice Location Address
First Line	:	2748 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2123
Country	:	US
Telephone Number	:	904-739-2242
Fax Number	:	904-739-0171

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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