Provider Demographics
NPI:1184463762
Name:RUDDER, ANTHONY ANDRE
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ANDRE
Last Name:RUDDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SUMMIT RIDGE RD S
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9611
Mailing Address - Country:US
Mailing Address - Phone:614-946-7349
Mailing Address - Fax:
Practice Address - Street 1:116 SUMMIT RIDGE RD S
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9611
Practice Address - Country:US
Practice Address - Phone:614-946-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle