Individual
GREGORY D RUDOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 BROADWAY STE 530, SEATTLE, WA 98122
(206) 386-2013
(206) 386-2149
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
MD00041809
WA
207Q00000X
Family Medicine Physician
MD00041809
WA
207QA0401X
Addiction Medicine (Family Medicine) Physician
MD00041809
WA
208VP0000X
Pain Medicine Physician
Primary
MD00041809
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1120542
—
WA
05
—
1871524728
—
WA
Enumeration date
07/06/2006
Last updated
06/02/2021
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