Healthcare Provider Details

I. General information

NPI: 1972054930
Provider Name (Legal Business Name): AARON RUGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 E I 240 SERVICE RD
OKLAHOMA CITY OK
73135-2607
US

IV. Provider business mailing address

5224 E I 240 SERVICE RD
OKLAHOMA CITY OK
73135-2607
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-3800
  • Fax:
Mailing address:
  • Phone: 405-608-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: