Provider Demographics
NPI:1316154685
Name:GWANZURA, RUDO (MD)
Entity type:Individual
Prefix:
First Name:RUDO
Middle Name:
Last Name:GWANZURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUDO
Other - Middle Name:
Other - Last Name:GWANZURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:210 B SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROAONKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4942
Mailing Address - Country:US
Mailing Address - Phone:252-535-8870
Mailing Address - Fax:252-535-8868
Practice Address - Street 1:210 B SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROAONKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4942
Practice Address - Country:US
Practice Address - Phone:252-535-8870
Practice Address - Fax:252-535-8868
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2075210Medicare PIN