Healthcare Provider Details

I. General information

NPI: 1699728865
Provider Name (Legal Business Name): JOSEPH F. RUWITCH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S WOODS MILL RD SUITE 760 NORTH
CHESTERFIELD MO
63017-3625
US

IV. Provider business mailing address

222 S WOODS MILL RD SUITE 760 NORTH
CHESTERFIELD MO
63017-3625
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6050
  • Fax: 314-434-5939
Mailing address:
  • Phone: 314-205-6050
  • Fax: 314-434-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30779
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: