Healthcare Provider Details

I. General information

NPI: 1952360695
Provider Name (Legal Business Name): DANIEL EDWARD RUTTERER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 US HWY 42
FLORENCE KY
41042-9642
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-647-2900
  • Fax: 859-647-0140
Mailing address:
  • Phone: 859-655-4111
  • Fax: 859-655-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22317
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: