Healthcare Provider Details

I. General information

NPI: 1558757211
Provider Name (Legal Business Name): TIMOTHY RUGILE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BROADWAY ST STE 230
NEW ORLEANS LA
70118-3544
US

IV. Provider business mailing address

1430 TULANE AVE # 8033
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-9000
  • Fax:
Mailing address:
  • Phone: 504-988-9000
  • Fax: 504-988-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number307947
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: