Provider Demographics
NPI:1376614008
Name:FLETCHER, DAVID RUDOLF (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUDOLF
Last Name:FLETCHER
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 1:126 S. HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408
Mailing Address - Country:US
Mailing Address - Phone:812-322-5779
Mailing Address - Fax:
Practice Address - Street 1:126 S. HAMPTON CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408
Practice Address - Country:US
Practice Address - Phone:812-322-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040668208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice