Healthcare Provider Details

I. General information

NPI: 1912912106
Provider Name (Legal Business Name): J D RUGGIERO MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
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 STE A
ORANGE PARK FL
32073-4462
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-3200
  • Fax: 904-272-3211
Mailing address:
  • Phone: 904-579-4692
  • Fax: 904-639-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. JOSEPH DAVID RUGGIERO
Title or Position: OWNER
Credential: MD
Phone: 904-834-1002