Individual
DR. JOHN BRADLEY RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
415 6TH ST STE 3C, LEWISTON, ID 83501-2431
(208) 750-7300
(208) 746-4899
Mailing address
415 6TH STREET, ATTN: PHYSICIAN SERVICES, LEWISTON, ID 83501-2434
(208) 750-7462
(208) 750-7467
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-0990
ID
207Q00000X
Family Medicine Physician
OP60506022
WA
Other
Enumeration date
04/03/2013
Last updated
12/26/2024
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