Provider Demographics
NPI:1467673327
Name:JOSEPH F RUDA JR MD (A MEDICAL CORPORATION )
Entity Type:Organization
Organization Name:JOSEPH F RUDA JR MD (A MEDICAL CORPORATION )
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:RUDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PYSICIAN MD
Authorized Official - Phone:559-332-2015
Mailing Address - Street 1:31671 INDIAN GUIDE RD
Mailing Address - Street 2:
Mailing Address - City:SQUAW VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93675-9676
Mailing Address - Country:US
Mailing Address - Phone:559-332-2015
Mailing Address - Fax:559-332-9105
Practice Address - Street 1:31671 INDIAN GUIDE RD
Practice Address - Street 2:
Practice Address - City:SQUAW VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93675-9676
Practice Address - Country:US
Practice Address - Phone:559-332-2015
Practice Address - Fax:559-332-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA324630207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A324630Medicaid
CA00A324630Medicaid
CA00A324630Medicare PIN
CAC21398Medicare UPIN