Individual
JOSEPH RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1011 BOWLES AVE, SUITE 300, FENTON, MO 63026-2395
(314) 496-5000
(314) 496-5015
Mailing address
10777 SUNSET OFFICE DR, SUITE 310, SAINT LOUIS, MO 63127-1019
(314) 822-5900
(314) 822-5919
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MOR4E01
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202083069
—
MO
Enumeration date
07/17/2006
Last updated
09/02/2009
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