Healthcare Provider Details

I. General information

NPI: 1174528806
Provider Name (Legal Business Name): FRED MICHAEL RUEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S 36TH ST
MUSKOGEE OK
74401-5043
US

IV. Provider business mailing address

209 S 36TH ST
MUSKOGEE OK
74401-5043
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-7717
  • Fax: 918-682-9434
Mailing address:
  • Phone: 918-682-7717
  • Fax: 918-682-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12652
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: