Provider Demographics
NPI:1043401441
Name:RUDD, ALEXANDRIA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:ELIZABETH
Last Name:RUDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:45 NE LOOP 410
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5832
Mailing Address - Country:US
Mailing Address - Phone:210-375-7780
Mailing Address - Fax:210-375-7789
Practice Address - Street 1:45 NE LOOP 410
Practice Address - Street 2:SUITE 900
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5832
Practice Address - Country:US
Practice Address - Phone:210-375-7780
Practice Address - Fax:210-375-7789
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM8967207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB112664OtherMEDICARE
TX195594003Medicaid