Provider Demographics
NPI:1497757686
Name:RUDERMAN, JEFFREY P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:RUDERMAN
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 1:1792 TRIBUTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4305
Mailing Address - Country:US
Mailing Address - Phone:916-678-5400
Mailing Address - Fax:916-678-7663
Practice Address - Street 1:1792 TRIBUTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4305
Practice Address - Country:US
Practice Address - Phone:916-678-5400
Practice Address - Fax:916-678-7663
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G679200Medicaid
CAG64075Medicare UPIN
CAAR211YMedicare PIN