Individual
DR. THEODORE L RUDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5430 E SAPPHIRE LN, PARADISE VALLEY, AZ 85253-2533
(602) 410-3293
Mailing address
5430 E SAPPHIRE LN, PARADISE VALLEY, AZ 85253-2533
(602) 410-3293
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
11018
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000BGJNC
—
AZ
01
—
029229
AM. BOARD OF FAMILY PRACT
—
Enumeration date
11/02/2005
Last updated
04/03/2014
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