Basic Information
| Provider Information | |||||||||
| NPI: | 1386712081 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BENNETT L RUDORFER MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 381974 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381831974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707322398 | ||||||||
| FaxNumber: | 8707323647 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 W TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707322398 | ||||||||
| FaxNumber: | 8707323647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | RUDORFER | ||||||||
| AuthorizedOfficialFirstName: | BENNETT | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 8707323790 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.