Provider Demographics
NPI:1033541875
Name:TIMOTHY J. RUDDELL, M.D., PLLC
Entity Type:Organization
Organization Name:TIMOTHY J. RUDDELL, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-957-1104
Mailing Address - Street 1:600 E TAYLOR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2832
Mailing Address - Country:US
Mailing Address - Phone:903-957-1104
Mailing Address - Fax:
Practice Address - Street 1:600 E TAYLOR ST STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2832
Practice Address - Country:US
Practice Address - Phone:903-957-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7029208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043466931OtherINDIVIDUAL NPI