Healthcare Provider Details

I. General information

NPI: 1225655657
Provider Name (Legal Business Name): JEFFREY SCOTT RUGGERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 09/09/2025
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD DEPT EMERGENCY MED
SAINT LOUIS MO
63136-6163
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-9123
  • Fax: 314-747-9160
Mailing address:
  • Phone: 314-362-9123
  • Fax: 314-747-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2022042058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: