Basic Information
Provider Information
NPI: 1003001793
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLASDICK
FirstName: RUDOLF
MiddleName: MONROE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 647
Address2:  
City: COPPELL
State: TX
PostalCode: 750190647
CountryCode: US
TelephoneNumber: 9723041635
FaxNumber:  
Practice Location
Address1: 757 ARMSTRONG BLVD
Address2:  
City: COPPELL
State: TX
PostalCode: 750194536
CountryCode: US
TelephoneNumber: 9723041635
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2007
LastUpdateDate: 09/06/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XC 8548TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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