Healthcare Provider Details

I. General information

NPI: 1053524744
Provider Name (Legal Business Name): AARON RUCKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/25/2021
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST FL 4
ERIE PA
16507-1427
US

IV. Provider business mailing address

300 STATE ST FL 4
ERIE PA
16507-1427
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberOS 016062
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: