Provider Demographics
NPI:1902117732
Name:RUDOLPH, CLARE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:ELIZABETH
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:E
Other - Last Name:RUDOLPH FRANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2170 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7026
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:2175 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7024
Practice Address - Country:US
Practice Address - Phone:530-543-5711
Practice Address - Fax:530-544-2503
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20907207V00000X
CAA124647207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology