Individual
DR. DOUGLAS RUDISILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 E WHEELER RD, MOSES LAKE, WA 98837-1820
(509) 765-5606
(253) 838-6418
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-5947
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
C42852
CA
207P00000X
Emergency Medicine Physician
Primary
MD60041375
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0243670
LIWA
WA
05
—
8531188
—
WA
01
—
9111RU
BSWA
WA
Enumeration date
12/13/2005
Last updated
08/18/2010
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