Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | P7029 | TX |
NPI | 1043466931 |
---|---|
Provider Name | Dr. Timothy John Ruddell |
First Address | Dallas, TX 75284-4658 |
Second Address | College Station, TX 77845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 30/08/2018 |