Provider Demographics
NPI:1275851701
Name:RUDERFER, JAMIE ERICA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ERICA
Last Name:RUDERFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5300 E ERICKSON DR STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2809
Practice Address - Country:US
Practice Address - Phone:520-324-7200
Practice Address - Fax:520-324-7201
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55664208000000X, 2080P0214X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ386304Medicaid