Healthcare Provider Details

I. General information

NPI: 1922076090
Provider Name (Legal Business Name): SEBASTIAN B RUGGERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 E INDIAN SCHOOL RD SUITE 200
PHOENIX AZ
85016
US

IV. Provider business mailing address

3104 E INDIAN SCHOOL RD SUITE 200
PHOENIX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-9484
  • Fax: 602-954-6433
Mailing address:
  • Phone: 602-954-9484
  • Fax: 602-954-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number12438
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: