Organization
THEODORE L RUDBERG MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE L RUDBERG MD (PRESIDENT)
(602) 410-3293
Entity
Organization
Contact information
Practice address
777 E MISSOURI AVE, STE 225, PHOENIX, AZ 85014-2830
(602) 263-8958
(602) 277-5661
Mailing address
5430 E SAPPHIRE LN, PARADISE VALLEY, AZ 85253-2533
(602) 410-3293
(480) 348-9679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11018
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245309
—
AZ
Enumeration date
06/25/2012
Last updated
06/25/2012
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