Healthcare Provider Details

I. General information

NPI: 1255404786
Provider Name (Legal Business Name): SETH M RUGGLES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 MILAN AVE SUITE 2
NORWALK OH
44857-0000
US

IV. Provider business mailing address

1031 PIERCE STREET SUITE D
SANDUSKY OH
44870
US

V. Phone/Fax

Practice location:
  • Phone: 419-668-4567
  • Fax: 419-668-4568
Mailing address:
  • Phone: 419-557-5541
  • Fax: 419-557-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: