# THEODORE L RUDBERG MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184988115
- **Authorized official:** THEODORE L RUDBERG MD (PRESIDENT)
- **Authorized official phone:** (602) 410-3293

## Contact information

- **Practice address:** 777 E MISSOURI AVE, STE 225, PHOENIX, AZ 85014-2830
- **Practice address phone:** (602) 263-8958
- **Practice address fax:** (602) 277-5661
- **Mailing address:** 5430 E SAPPHIRE LN, PARADISE VALLEY, AZ 85253-2533
- **Mailing address phone:** (602) 410-3293
- **Mailing address fax:** (480) 348-9679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11018 | AZ | Yes |

## Other

- **Enumeration date:** 06/25/2012
- **Last updated:** 06/25/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 245309 | — | AZ |