Healthcare Provider Details

I. General information

NPI: 1376539593
Provider Name (Legal Business Name): LAWRENCE E RUF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD STE 501
POOLER GA
31322-4061
US

IV. Provider business mailing address

1000 TOWNE CENTER BLVD STE 501
POOLER GA
31322-4061
US

V. Phone/Fax

Practice location:
  • Phone: 912-988-1781
  • Fax: 912-777-7591
Mailing address:
  • Phone: 912-988-1781
  • Fax: 912-777-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number21583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: