Healthcare Provider Details

I. General information

NPI: 1114115581
Provider Name (Legal Business Name): CHRISTOPHER LOUIS RUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GREENWICH RD STE 8
NORTON OH
44203-5780
US

IV. Provider business mailing address

3515 MASSILLON RD SUITE 300
UNIONTOWN OH
44685-6400
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-7371
  • Fax: 330-825-7482
Mailing address:
  • Phone: 330-899-9350
  • Fax: 330-634-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-092406
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-092406
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: