NPI 1104182328

Carla Rudolph, DO

Practitioner General Practice Physician Edgewood, NM

Practice location

Address: 1851 Old US 66, Edgewood, NM 87015-7200
Phone: (505) 286-2396

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence A-1770-13 (NM)

Other General Practice providers in New Mexico →

Registry record

NPI: 1104182328
Entity type: Individual
Sex (as registered): Female
NPI issued: 2 Apr 2012
Record last updated: 4 May 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.