Healthcare Provider Details

I. General information

NPI: 1669576757
Provider Name (Legal Business Name): CHARLES J RUZKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N GRAND AVE SUITE 150
PUEBLO CO
81003-2749
US

IV. Provider business mailing address

PO BOX 560825
DENVER CO
80256-0825
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7680
  • Fax: 719-595-7687
Mailing address:
  • Phone: 719-595-7580
  • Fax: 719-545-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-23100
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number39991
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: