Individual
DR. RUDY HARTONO TAAREA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
511 BRANTLEY ST, OPP, AL 36467-1702
(334) 493-3240
Mailing address
511 BRANTLEY ST, OPP, AL 36467-1702
(334) 493-3240
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
Primary
AL19483
AL
Other
Enumeration date
11/18/2005
Last updated
11/20/2012
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