Provider Demographics
NPI:1174889794
Name:RUDD, JUSTIN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:RUDD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8762
Mailing Address - Fax:337-312-8044
Practice Address - Street 1:501 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-312-8762
Practice Address - Fax:337-312-8044
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2018-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA309562208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery