Provider Demographics
NPI:1922218429
Name:RUDD, JAMES ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:RUDD
Suffix:JR
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 1:206 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4856
Mailing Address - Country:US
Mailing Address - Phone:337-463-5582
Mailing Address - Fax:337-460-1348
Practice Address - Street 1:206 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4856
Practice Address - Country:US
Practice Address - Phone:337-463-5582
Practice Address - Fax:337-460-1348
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology