Provider Demographics
NPI:1598704843
Name:RUDERMAN, WILLIAM BRANDON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRANDON
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 1:1817 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-896-1726
Mailing Address - Fax:407-896-9716
Practice Address - Street 1:1817 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-896-1726
Practice Address - Fax:407-896-9716
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52137207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047657900Medicaid
FL04913YMedicare ID - Type Unspecified
FL04913WMedicare PIN
FL047657900Medicaid
FL04913XMedicare PIN