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Carla Rudolph, DO
General Practice Physician in Edgewood, New Mexico
NPI 1104182328

Carla Rudolph is a General Practice Physician based in Edgewood, NM. Carla Rudolph practices in Edgewood, NM and has the professional credentials of DO. The NPI Number for Carla Rudolph is 1104182328 and holds a License No. A-1770-13 (New Mexico).

The current practice location address for Carla Rudolph is 1851 Old Us 66, Edgewood, NM and can be reached out via phone at 505-286-2396.

Location: 1851 Old Us 66, Edgewood, NM, 87015-7200
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104182328
Provider Name
Carla Rudolph
Credential
DO
Provider Entity Type
Individual
Gender
Female
Address
1851 Old Us 66, Edgewood, NM, 87015-7200
Phone Number
505-286-2396
Fax Number
Provider Enumeration Date
04/02/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1104182328 05 NC
institution
Provider Business Practice Location Address Details
Address
1851 Old Us 66
City
Edgewood
State
New Mexico
Zip
87015-7200
Phone Number
505-286-2396
Fax Number
person
Provider Business Mailing Address Details
Address
1851 Old Us 66
City
Edgewood
State
New Mexico
Zip
87015-7200
Phone Number
505-286-2396
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
A-1770-13 (New Mexico)
Definition
Definition to come...
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