Provider Demographics
NPI:1356437305
Name:RUDAWSKY, RON
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:RUDAWSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:RUDAWSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1501 S. POTOMAC ST.
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5411
Practice Address - Country:US
Practice Address - Phone:303-695-2628
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1681207R00000X
COPA.0001681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00730991OtherRAILROAD MEDICARE
CO71403540Medicaid
COP00730991OtherRAILROAD MEDICARE
COCO300151Medicare PIN
COP96074Medicare UPIN