Healthcare Provider Details

I. General information

NPI: 1346221348
Provider Name (Legal Business Name): J D RUGGIERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 PROFESSIONAL CENTER DR SUITE A
ORANGE PARK FL
32073-4492
US

IV. Provider business mailing address

2035 PROFESSIONAL CENTER DR SUITE A
ORANGE PARK FL
32073-4492
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-3200
  • Fax: 904-272-3211
Mailing address:
  • Phone: 904-272-3200
  • Fax: 904-272-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME67983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: