Provider Demographics
NPI:1184806044
Name:MALCOLM RUDE, M.D., P.A.
Entity type:Organization
Organization Name:MALCOLM RUDE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:RUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-8825
Mailing Address - Street 1:2809 EARL RUDDER FWY S
Mailing Address - Street 2:STE 101
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6080
Mailing Address - Country:US
Mailing Address - Phone:979-776-8825
Mailing Address - Fax:979-776-2655
Practice Address - Street 1:2809 EARL RUDDER FWY S
Practice Address - Street 2:STE 101
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6080
Practice Address - Country:US
Practice Address - Phone:979-776-8825
Practice Address - Fax:979-776-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9893208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8743OtherMEDICARE INDIVIDUAL
TX0046LNOtherBCBS
TX166208201Medicaid
TX00730WMedicare PIN
TX8B8743OtherMEDICARE INDIVIDUAL