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Organization
TIMOTHY RUDOLPH MD PA
Active
Organization
TIMOTHY RUDOLPH MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA L HARDIN (OFC CEO)
(254) 223-0950
Entity
Organization
Contact information
Practice address
400 N BROWN ST, HAMILTON, TX 76531-1518
(254) 386-1600
(254) 386-4950
Mailing address
639 LEE RD, HAMILTON, TX 76531-1700
(254) 223-0950
(972) 722-0417
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199796703
—
TX
Enumeration date
06/11/2019
Last updated
06/11/2019
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