Individual
THEODOR MAJOR RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3900 20TH ST, VERO BEACH, FL 32960-2413
(772) 299-4000
(772) 299-4001
Mailing address
3900 20TH ST, VERO BEACH, FL 32960-2413
(772) 299-4000
(772) 299-4001
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME79805
FL
207ND0101X
MOHS-Micrographic Surgery Physician
ME79805
FL
207NP0225X
Pediatric Dermatology Physician
ME79805
FL
207NS0135X
Procedural Dermatology Physician
ME79805
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261870200
—
FL
Enumeration date
12/07/2005
Last updated
09/14/2020
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