Provider Demographics
NPI:1629089941
Name:RUDIN, GUY J ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:J ALEXANDER
Last Name:RUDIN
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:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-3067
Mailing Address - Country:US
Mailing Address - Phone:530-751-4784
Mailing Address - Fax:530-751-4906
Practice Address - Street 1:370 DEL NORTE AVE STE 201
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-751-7201
Practice Address - Fax:530-751-2704
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44255207X00000X
CAG65200207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83161Medicare UPIN