MEDICARE: MR. TOM RICHARD RUDDY

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	103T00000X	Psychologist		AZ

General Provider Information

NPI Number	:	1922209493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOM RICHARD RUDDY

Provider Business Mailing Address
First Line	:	2524 S EL PARADISO UNIT 10
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7477
Country	:	US
Telephone Number	:	480-313-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 S EL PARADISO UNIT 10
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7477
Country	:	US
Telephone Number	:	480-313-2468
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/26/2007

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Directions to “ MR. TOM RICHARD RUDDY ” Practice Location

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