Healthcare Provider Details

I. General information

NPI: 1215933643
Provider Name (Legal Business Name): JOSEPH W RUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 STEIN BLVD
EAU CLAIRE WI
54701-4398
US

IV. Provider business mailing address

3221 STEIN BLVD
EAU CLAIRE WI
54701-4398
US

V. Phone/Fax

Practice location:
  • Phone: 715-833-2116
  • Fax: 715-833-1068
Mailing address:
  • Phone: 715-833-2116
  • Fax: 715-833-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26172
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: