Healthcare Provider Details

I. General information

NPI: 1467438291
Provider Name (Legal Business Name): KENNETH S. RUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 DATAPOINT DR STE 600
SAN ANTONIO TX
78229-5907
US

IV. Provider business mailing address

8401 DATAPOINT, P. O. BOX 29441 SUITE 600
SAN ANTONIO TX
78229-0441
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-7700
  • Fax: 210-616-7709
Mailing address:
  • Phone: 210-616-7796
  • Fax: 210-616-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberF8655
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberF8655
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF8655
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberF8655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: