Individual
DR. JAMES RAYMOND RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5531
Mailing address
1848 S DEER PARK DR, PERU, IN 46970-7279
(765) 472-7629
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01031169A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100366510
—
IN
05
—
100366510A
—
IN
Enumeration date
07/17/2006
Last updated
04/15/2013
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