Healthcare Provider Details

I. General information

NPI: 1821142829
Provider Name (Legal Business Name): JEFFREY ALLYN RUTERBUSCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PARKRIDGE AVE
ORANGE PARK FL
32065-7507
US

IV. Provider business mailing address

316 PARKRIDGE AVE
ORANGE PARK FL
32065-7507
US

V. Phone/Fax

Practice location:
  • Phone: 904-589-0750
  • Fax: 904-375-8821
Mailing address:
  • Phone: 904-589-0750
  • Fax: 904-375-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS6403
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS6403
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0006403
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberOS6403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: