Provider Demographics
NPI:1992793111
Name:GREENE, RUDY R (MD)
Entity type:Individual
Prefix:
First Name:RUDY
Middle Name:R
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CATALINA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1605
Mailing Address - Country:US
Mailing Address - Phone:541-535-5523
Mailing Address - Fax:541-535-5368
Practice Address - Street 1:540 CATALINA DRIVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1605
Practice Address - Country:US
Practice Address - Phone:541-535-5523
Practice Address - Fax:541-535-5368
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20960207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48334Medicare UPIN