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NPI Code Detail

MEDICARE: MRS. ELIZABETH ANN RUGG PA, NP

MEDICARE: MRS. ELIZABETH ANN RUGG PA, NP
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
1363AM0700XMedical Physician AssistantPA 16471CA
2363A00000XPhysician AssistantPA169785OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
116471OTHERCAPHYSICIAN ASSISTANT
2PA169785OTHEROROR PA LICENSE

General Provider Information

NPI Number : 1417927922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ANN RUGG PA, NP
Provider Business Mailing Address
First Line : 3617 S PACIFIC HWY
Second Line :
City : MEDFORD
State : OR
Zip : 97501-8957
Country : US
Telephone Number : 541-690-3600
Fax Number : 541-664-3735
Provider Business Practice Location Address
First Line : 4940 HAMRICK RD
Second Line :
City : CENTRAL POINT
State : OR
Zip : 97502-3072
Country : US
Telephone Number : 541-690-3600
Fax Number : 541-664-3735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 01/22/2016

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