Provider Demographics
NPI:1609098854
Name:RUDDERHAM, MARK H (NMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:RUDDERHAM
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7949 E ACOMA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6908
Mailing Address - Country:US
Mailing Address - Phone:602-350-5600
Mailing Address - Fax:602-368-9512
Practice Address - Street 1:7949 E ACOMA DR STE 208
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6908
Practice Address - Country:US
Practice Address - Phone:602-350-5600
Practice Address - Fax:602-368-9512
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ97-495175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath