Provider Demographics
NPI:1437357498
Name:RUDA, STEPHEN DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DANIEL
Last Name:RUDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WHITNEY FARM RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-6300
Mailing Address - Country:US
Mailing Address - Phone:925-586-7935
Mailing Address - Fax:
Practice Address - Street 1:111 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9386207Q00000X
MEDO2278207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine