Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD067886L | PA |
NPI | 1023052446 |
---|---|
Provider Name | Dr. Jason W. Rudolph |
First Address | Bethlehem, PA 18017-7307 |
Second Address | Bethlehem, PA 18017-7307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017598980001 | (05) | PA |
S68239 | (02) |