Healthcare Provider Details

I. General information

NPI: 1437187077
Provider Name (Legal Business Name): PAUL E. RUGGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 4TH AVE E SUITE 200
NEWTON IA
50208-3155
US

IV. Provider business mailing address

300 N 4TH AVE E SUITE 200
NEWTON IA
50208-3155
US

V. Phone/Fax

Practice location:
  • Phone: 641-792-2112
  • Fax: 641-792-8484
Mailing address:
  • Phone: 641-792-2112
  • Fax: 641-792-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22612
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: