Individual
JONATHAN B RUDOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 325-5011
(505) 324-2259
Mailing address
4101 CRISTO REY ST, FARMINGTON, NM 87401-8615
(505) 325-4380
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2004-0021
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97526550
—
NM
Enumeration date
02/17/2006
Last updated
08/20/2015
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