Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS015499L | PA |
NPI | 1023072576 |
---|---|
Provider Name | Dr. Donald Rudolf |
First Address | Doylestown, PA 18901-2511 |
Second Address | Doylestown, PA 18901-2511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 28/03/2008 |