Individual
CHARLES E RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3115 LOOP 306, SUITE 110, SAN ANGELO, TX 76904-5983
(325) 942-1952
(325) 942-1517
Mailing address
3115 LOOP 306, SUITE 110, SAN ANGELO, TX 76904-5983
(325) 942-1952
(325) 942-1517
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
21568
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87710A
BCBS PSHCHSPRING
TX
Enumeration date
07/10/2006
Last updated
05/20/2008
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