Healthcare Provider Details

I. General information

NPI: 1023129954
Provider Name (Legal Business Name): REBECCA V RUGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GRAHAM RD STE 2320C
FLORISSANT MO
63031-8012
US

IV. Provider business mailing address

1225 GRAHAM RD STE C-2320
FLORISSANT MO
63031-8030
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-6801
  • Fax: 314-953-6819
Mailing address:
  • Phone: 314-953-6801
  • Fax: 314-953-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number104854
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: