Provider Demographics
NPI:1922084342
Name:RUDLOFF, ROGER PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
Last Name:RUDLOFF
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 109
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-0109
Mailing Address - Country:US
Mailing Address - Phone:402-887-5440
Mailing Address - Fax:402-887-4564
Practice Address - Street 1:109 W 11TH ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1065
Practice Address - Country:US
Practice Address - Phone:402-887-5440
Practice Address - Fax:402-887-4564
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE19913Medicaid
NE266364RUMedicare ID - Type Unspecified
NENE19913Medicaid