Provider Demographics
NPI:1831372366
Name:R PATRICK RUDY MD PA
Entity type:Organization
Organization Name:R PATRICK RUDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-338-2400
Mailing Address - Street 1:450 MEDICAL CENTER BLVD
Mailing Address - Street 2:# 300
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4233
Mailing Address - Country:US
Mailing Address - Phone:281-338-2400
Mailing Address - Fax:281-338-2744
Practice Address - Street 1:450 MEDICAL CENTER BLVD
Practice Address - Street 2:# 300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4233
Practice Address - Country:US
Practice Address - Phone:281-338-2400
Practice Address - Fax:281-338-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21402OtherUPIN
TX1147084-02Medicaid
TX=========OtherTID
TX=========OtherTID
TX1147084-02Medicaid