Healthcare Provider Details

I. General information

NPI: 1902164098
Provider Name (Legal Business Name): GEORGE RICHARD RUEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SUNSET BLVD
WEST COLUMBIA SC
29169-4810
US

IV. Provider business mailing address

525 E MARKET ST
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-2460
  • Fax: 803-791-2519
Mailing address:
  • Phone: 330-375-3771
  • Fax: 330-375-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number83768
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35134280
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number83768
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: