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NPI Code Detail

MEDICARE: JENNIFER MAIN RUTBERG MD

MEDICARE: JENNIFER MAIN RUTBERG MD
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
1207R00000XInternal Medicine Physician0054276CO

General Provider Information

NPI Number : 1801950118
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MAIN RUTBERG MD
Provider Business Mailing Address
First Line : 1109 HEPPLEWHITE CT
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-3821
Country : US
Telephone Number : 970-810-4700
Fax Number :
Provider Business Practice Location Address
First Line : 303 COLLAND DR
Second Line : BANNER HEALTH CLINIC
City : FORT COLLINS
State : CO
Zip : 80525-4205
Country : US
Telephone Number : 970-461-8031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 10/18/2021

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