Healthcare Provider Details

I. General information

NPI: 1780945964
Provider Name (Legal Business Name): BENJAMIN R RUCKMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 MIDPOINT DR STE B
FORT COLLINS CO
80525-4408
US

IV. Provider business mailing address

2637 MIDPOINT DR STE B
FORT COLLINS CO
80525-4408
US

V. Phone/Fax

Practice location:
  • Phone: 970-488-1640
  • Fax:
Mailing address:
  • Phone: 970-488-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0053866
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0053866
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: