Provider Demographics
NPI:1790796662
Name:TOVAR, RUDOLPH M (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:M
Last Name:TOVAR
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 1:328 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3866
Mailing Address - Country:US
Mailing Address - Phone:972-436-7557
Mailing Address - Fax:972-221-8246
Practice Address - Street 1:328 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3866
Practice Address - Country:US
Practice Address - Phone:972-436-7557
Practice Address - Fax:972-221-8246
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9689207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046431503Medicaid
TX046431502Medicaid
TX046433101Medicaid
TX8BJ297OtherBCBS
TX8BJ297OtherBCBS
TX882376Medicare ID - Type Unspecified