Healthcare Provider Details

I. General information

NPI: 1548656432
Provider Name (Legal Business Name): GAETANO TREY RUGGIERO III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TREY RUGGIERO MD

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE
BATON ROUGE LA
70809
US

IV. Provider business mailing address

8585 PICARDY AVE
BATON ROUGE LA
70809-3748
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-4764
  • Fax: 225-763-4549
Mailing address:
  • Phone: 225-387-7918
  • Fax: 225-372-3717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number309555
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: