Provider Demographics
NPI:1346247418
Name:RUEDAS, BEETHOVEN T (MD)
Entity Type:Individual
Prefix:DR
First Name:BEETHOVEN
Middle Name:T
Last Name:RUEDAS
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 1:4231 SNOWDON LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1627
Mailing Address - Country:US
Mailing Address - Phone:904-641-7082
Mailing Address - Fax:
Practice Address - Street 1:865 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8917
Practice Address - Country:US
Practice Address - Phone:904-276-1133
Practice Address - Fax:904-276-1821
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252256000Medicaid
FLD50306Medicare UPIN
FL02047ZMedicare ID - Type Unspecified
FL02047VMedicare PIN