MEDICARE: SHARON E RUCH MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	12553	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12553	OTHER	NV	LICENCE

General Provider Information

NPI Number	:	1043677784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON E RUCH MD PLLC

Provider Business Mailing Address
First Line	:	10604 SAN BELLACOVA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3985
Country	:	US
Telephone Number	:	702-614-1250
Fax Number	:	949-215-5044

Provider Business Practice Location Address
First Line	:	10604 SAN BELLACOVA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3985
Country	:	US
Telephone Number	:	702-614-1250
Fax Number	:	949-215-5044

Authorized Official
Title or Position	:	OWNER MEDICAL DIRECTOR
Name	:	SHARON E RUCH
Credential	:	MD
Telephone Number	:	702-614-1250

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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