Healthcare Provider Details

I. General information

NPI: 1487738308
Provider Name (Legal Business Name): GAIL MONICA RUCKER D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 ESTATE THOMAS STE 206 FOOTHILLS PROFESSIONAL BLDG.
ST THOMAS VI
00802-3634
US

IV. Provider business mailing address

9160 ESTATE THOMAS
ST THOMAS VI
00802-3641
US

V. Phone/Fax

Practice location:
  • Phone: 340-779-2663
  • Fax: 340-779-2443
Mailing address:
  • Phone: 340-779-2663
  • Fax: 340-779-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1475
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO445
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: