Richard N Rudnicki, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

J2769 Issued in TX

Practice address

3330 N Galloway Ave Ste 304
Mesquite, TX 75150-4767

Phone

(972) 289-2233

NPI assigned

Dec 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1166313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518566400000",
    "number": "1407919160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 N GALLOWAY AVE STE 304",
            "address_2": "PMB 91",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504767",
            "telephone_number": "214-796-9383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 N GALLOWAY AVE STE 304",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751504767",
            "telephone_number": "972-289-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDNICKI",
        "first_name": "RICHARD",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-17",
        "last_updated": "2018-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "J2769",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J2769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0847576-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; 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.