Provider Demographics
NPI:1306841994
Name:RUDE, MALCOLM J (M D)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:J
Last Name:RUDE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 EARL RUDDERY FWY S
Mailing Address - Street 2:STE 101
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6080
Mailing Address - Country:US
Mailing Address - Phone:979-776-8825
Mailing Address - Fax:979-776-2655
Practice Address - Street 1:2809 EARL RUDDERY FWY S
Practice Address - Street 2:STE 101
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6080
Practice Address - Country:US
Practice Address - Phone:979-776-8825
Practice Address - Fax:979-776-2655
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9893208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166208201Medicaid
TX0046LNOtherBCBS
TXI06476Medicare UPIN
TX00730WMedicare ID - Type UnspecifiedGROUP
TX8B8743Medicare ID - Type UnspecifiedINDIVIDUAL