Provider Demographics
NPI:1811227838
Name:DR. ANDREW S. RUDIN, M.D., P.C.
Entity Type:Organization
Organization Name:DR. ANDREW S. RUDIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-431-8002
Mailing Address - Street 1:PO BOX 3126
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38303-3126
Mailing Address - Country:US
Mailing Address - Phone:731-431-8002
Mailing Address - Fax:
Practice Address - Street 1:111 STONEBRIDGE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2040
Practice Address - Country:US
Practice Address - Phone:731-431-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty