Healthcare Provider Details

I. General information

NPI: 1568495935
Provider Name (Legal Business Name): LOUIS SCHRUFF JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 BROAD BRANCH CT
MC LEAN VA
22101-2140
US

IV. Provider business mailing address

601 E FRONT AVE SUITE 502
COEUR D ALENE ID
83814-2701
US

V. Phone/Fax

Practice location:
  • Phone: 866-400-4295
  • Fax: 208-763-3644
Mailing address:
  • Phone: 208-415-0595
  • Fax: 208-763-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number023860
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: