MR. RANDALL L RUDEEN (NPI# 1396763793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396763793 |
| Entity Type | Individual |
| Full Name | MR. RANDALL L RUDEEN |
| Credential | MD |
| Practice Address |
4424 E Flamingo Ave Suite 200 Nampa ID 83687-9300 |
| Mailing Address |
3340 E Goldstone Way Meridian ID 83642-1026 |
| Practice Telephone | 2082884888 |
| Practice Fax Number | 2082884890 |
| Mailing Telephone | 2083675170 |
| Mailing Fax Number | 2083675180 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-12-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | M5040 | ID | Other Service Providers |
| Y | 207V00000X | Obstetrics & Gynecology | M-5040 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 002648200 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952632358 | Randall Lee Rudeen | Chiropractor | 1700 Alma Dr, Plano, TX 75075-6937 | 2010-01-25 |
| Street Address |
4424 E FLAMINGO AVE SUITE 200 |
| City | NAMPA |
| State | ID |
| Zip Code | 83687-9300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356339618 | Randolph C Byrd | Internal Medicine | 4424 E Flamingo Ave, Suite 300, Nampa, ID 83687-9306 | 2005-10-11 |
| 1154840270 | Emma Nelson | Physical Therapist | 4424 E Flamingo Ave, Nampa, ID 83687-9289 | 2017-09-11 |
| 1750839502 | Boyd Layton | Physician Assistant | 4424 E Flamingo Ave, Suite 110, Nampa, ID 83687-9289 | 2016-09-21 |
| 1386191500 | Tarasue C Maness | Nurse Practitioner | 4424 E Flamingo Ave, Ste 310, Nampa, ID 83687 | 2016-09-06 |
| 1477932523 | Steen Edwards | Physical Therapist | 4424 E Flamingo Ave, Nampa, ID 83687-9289 | 2015-05-22 |
| 1477949261 | John Lattin | Physical Medicine & Rehabilitation | 4424 E Flamingo Ave, Suite 310, Nampa, ID 83687 | 2015-04-08 |
| 1588084453 | Jeffery Reese | Obstetrics & Gynecology | 4424 E Flamingo Ave, Ste 200, Nampa, ID 83687 | 2014-04-18 |
| 1588096804 | Branson J Collins | Anesthesiology | 4424 E Flamingo Ave, Nampa, ID 83687-9289 | 2013-08-09 |
| 1033473285 | Purushothaman Muthusamy | Internal Medicine | 4424 E Flamingo Ave, Ste 300, Nampa, ID 83687 | 2012-07-02 |
| 1639214216 | Tosha Jo Johnson | Nurse Practitioner | 4424 E Flamingo Ave, Suite 300, Nampa, ID 83687-9306 | 2007-02-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699307447 | Current Physical Therapy Nampa LLC | Physical Therapist | 16150 N High Desert Street, Nampa, ID 83687 | 2020-02-10 |
| 1356867683 | Nampa of Cascadia, LLC | Skilled Nursing Facility | 900 North Happy Valley Rd, Nampa, ID 83687 | 2017-08-18 |
| 1750828513 | Daniel & Max, LLC | Optometrist | 1600 Karcher Rd, Nampa, ID 83687 | 2017-01-31 |
| 1578965422 | Jorge Domingo Reyes | Counselor | 5700 E. Franklin Rd., Suite 220-i, Nampa, ID 83687 | 2014-09-23 |
| 1619302080 | David Lyle Farris | Dentist | 16548 North Franklin Blvd., Nampa, ID 83687 | 2013-09-04 |
| 1871934547 | Ian Zafar Qureshi | Internal Medicine | 4400 E Flamingo Ave Ste 130, Nampa, ID 83687 | 2013-07-10 |
| 1457696783 | Laurel Evans | Specialist/Technologist | 850 W. St. Luke's Dr., Suite 215, Nampa, ID 83687 | 2012-11-27 |
| 1750641197 | Andrea Patricia Fitzer | Nurse Practitioner | 4400 E. Flamingo Ave, Nampa, ID 83687 | 2012-05-18 |
| 1679846182 | Ivony Case Management | Case Management | 811 12th Street, Ste. 2, Nampa, ID 83687 | 2012-02-14 |
| 1699043679 | Saltzer Medical Group, P.a. | Durable Medical Equipment & Medical Supplies | 9850 W St Lukes Drive, Nampa, ID 83687 | 2011-12-06 |
| Find all providers in zip 83687 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609222355 | Brennan Anderson | Obstetrics & Gynecology | 4424 E Flamingo Ave Ste 200, Nampa, ID 83687-9300 | 2016-05-12 |
| 1902179914 | Gary Gregerson Md Pa | Obstetrics & Gynecology | 1611 12th Ave Road, Suite A, Nampa, ID 83686-6182 | 2012-02-22 |
| 1770513228 | Dustan Thomas Hughes | Obstetrics & Gynecology | 1611 B 12th Ave Rd, Lifestages Obgyn, Nampa, ID 83686 | 2006-07-03 |
| 1588084453 | Jeffery Reese | Obstetrics & Gynecology | 4424 E Flamingo Ave, Ste 200, Nampa, ID 83687 | 2014-04-18 |
| 1255762506 | Gary Gregerson, M.d., P.a. | Obstetrics & Gynecology | 1611 12th Ave Rd, Suite A, Nampa, ID 83686-7715 | 2013-12-11 |
| 1487092292 | Ryan Pettit | Obstetrics & Gynecology | 4424 E Flamingo, Ste 200, Nampa, ID 83687 | 2013-06-13 |
| 1700105921 | Melissa Germany Arnold | Obstetrics & Gynecology | 9850 W St Lukes Dr Ste 129, Nampa, ID 83687-7912 | 2010-05-27 |
| 1881828010 | Guillermo M Guzman Trevino | Obstetrics & Gynecology | 4424 E Flamingo, Suite 200, Nampa, ID 83687-9300 | 2009-05-01 |
| 1285757104 | Megan E Kasper | Obstetrics & Gynecology | 9850 St Lukes Dr, Nampa, ID 83687-7912 | 2007-04-07 |
| 1871618892 | Lifestages Ob-gyn Pllc | Obstetrics & Gynecology | 1611 12th Ave Rd Ste B, Nampa, ID 83686-6182 | 2007-03-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.