Organization
TIMOTHY J. RUDDELL, M.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J. RUDDELL M.D. (MANAGER)
(903) 957-1104
Entity
Organization
Contact information
Practice address
600 E TAYLOR ST STE 201, SHERMAN, TX 75090-2832
(903) 957-1104
Mailing address
600 E TAYLOR ST STE 201, SHERMAN, TX 75090-2832
(903) 957-1104
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
P7029
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043466931
INDIVIDUAL NPI
TX
Enumeration date
08/03/2013
Last updated
08/03/2013
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