Provider Demographics
NPI:1427398296
Name:SCHMIEDECKE, RUDY F (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:F
Last Name:SCHMIEDECKE
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 1:2050 BARB ST
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315
Mailing Address - Country:US
Mailing Address - Phone:360-315-4346
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-2050
Practice Address - Country:US
Practice Address - Phone:619-532-9660
Practice Address - Fax:619-532-9458
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132164171000000X, 207N00000X
CAA123164207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No171000000XOther Service ProvidersMilitary Health Care Provider
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology