Theodore L Rudberg MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11018 Issued in AZ

Legal business name

THEODORE L RUDBERG MD PC

Practice address

777 E Missouri Ave
Ste 225
Phoenix, AZ 85014-2830

Phone

(602) 263-8958

Fax

(602) 277-5661

NPI assigned

Jun 25, 2012

Last updated

Jun 25, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theodore L Rudberg, MDNPI 1033100615

Title

President

Phone

(602) 410-3293

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theodore L Rudberg, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Paradise Valley, AZ
  • NPI 1033100615
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1184988115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 E SAPPHIRE LN",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852532533",
            "telephone_number": "602-410-3293",
            "fax_number": "480-348-9679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 E MISSOURI AVE",
            "address_2": "STE 225",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142830",
            "telephone_number": "602-263-8958",
            "fax_number": "602-277-5661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE L RUDBERG MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "RUDBERG",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-410-3293",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "11018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "245309",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.