Healthcare Provider Details

I. General information

NPI: 1760428312
Provider Name (Legal Business Name): CREED MONROE RUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 N WILMOT RD
TUCSON AZ
85711-2701
US

IV. Provider business mailing address

677 N WILMOT RD
TUCSON AZ
85711-2701
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-2889
  • Fax: 520-795-6321
Mailing address:
  • Phone: 520-795-2889
  • Fax: 520-795-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number36409
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number36409
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36073
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME147128
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number36409
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36409
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: