Provider Demographics
NPI:1972629707
Name:RUDD, LAWRENCE JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JEFFREY
Last Name:RUDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1414 RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4516
Mailing Address - Country:US
Mailing Address - Phone:626-795-3339
Mailing Address - Fax:626-795-3369
Practice Address - Street 1:1414 RIDGE WAY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4516
Practice Address - Country:US
Practice Address - Phone:626-795-3339
Practice Address - Fax:626-795-3369
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 39925207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine