Provider Demographics
NPI:1972614972
Name:RUDD, RICHARD NEIL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEIL
Last Name:RUDD
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2528
Mailing Address - Country:US
Mailing Address - Phone:916-854-6666
Mailing Address - Fax:916-854-6864
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2190
Practice Address - Country:US
Practice Address - Phone:510-204-8160
Practice Address - Fax:510-841-5535
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42981207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G429810Medicaid
A49183Medicare UPIN