Provider Demographics
NPI:1023008778
Name:RUDD, CHARLES WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:RUDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 BRETSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-3704
Mailing Address - Country:US
Mailing Address - Phone:713-633-2100
Mailing Address - Fax:713-633-2103
Practice Address - Street 1:7030 BRETSHIRE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-3704
Practice Address - Country:US
Practice Address - Phone:713-633-2100
Practice Address - Fax:713-633-2103
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-7470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67590Medicare UPIN
TX80A546Medicare PIN