Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 55664 | AZ |
Y | 2080P0214X | Pediatric Pulmonologist | 55664 | AZ |
NPI | 1275851701 |
---|---|
Provider Name | Dr. Jamie Erica Ruderfer |
First Address | Tucson, AZ 85751-1235 |
Second Address | Tucson, AZ 85712-2809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
386304 | (05) | AZ |