Provider Demographics
NPI:1235245416
Name:RUDEN, EDWARD LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LESLIE
Last Name:RUDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1059
Mailing Address - Country:US
Mailing Address - Phone:503-777-3311
Mailing Address - Fax:
Practice Address - Street 1:7705 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1059
Practice Address - Country:US
Practice Address - Phone:503-777-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21394208000000X
WAMD00036789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics