Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A113303 | CA |
N | 208600000X | Surgeon | A113303 | CA |
N | 208200000X | Surgeon | DR.0055303 | CO |
N | 208600000X | Surgeon | DR.0055303 | CO |
N | 208G00000X | Cardiothoracic Vascular Surgeon | A113303 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | DR.0055303 | CO |
NPI | 1033374186 |
---|---|
Provider Name | Dr. Patrick Donohue Rudersdorf |
First Address | Lakewood, CO 80228-1704 |
Second Address | Lakewood, CO 80228-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 30/10/2015 |