Healthcare Provider Details

I. General information

NPI: 1538729124
Provider Name (Legal Business Name): LAWRENCE E RUF MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
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 Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE E RUF
Title or Position: OWNER
Credential: MD
Phone: 912-988-1781