Provider Demographics
NPI:1114223898
Name:JAMES R. RUDD SR., M.D., LLC
Entity Type:Organization
Organization Name:JAMES R. RUDD SR., M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-463-5582
Mailing Address - Street 1:206 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4856
Mailing Address - Country:US
Mailing Address - Phone:337-463-5582
Mailing Address - Fax:337-460-1348
Practice Address - Street 1:206 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4856
Practice Address - Country:US
Practice Address - Phone:337-463-5582
Practice Address - Fax:337-460-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15081261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1329754Medicaid
LA1329754Medicaid