Provider Demographics
NPI:1588481428
Name:ANTOINE, RUDOLPH
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 S ROBESON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6340
Mailing Address - Country:US
Mailing Address - Phone:843-731-1918
Mailing Address - Fax:
Practice Address - Street 1:2412 S ROBESON AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6340
Practice Address - Country:US
Practice Address - Phone:843-731-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBS.58740171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications