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General NPI Number Information
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NPI Number | 1174706519
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Entity Type | Organization
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Legal Business Name | A. CLARK RUTTINGER D O PLLC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 13951 W GRAND AVE STE 203
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City | SURPRISE
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State | AZ
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Zip | 85374-2436
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Country | US
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Telephone | 623-544-4600
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Fax | 623-544-4725
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Provider Business Mailing Address
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Address Line | 13951 W GRAND AVE STE 203
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City | SURPRISE
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State | AZ
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Zip | 85374-2436
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Country | US
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Telephone | 623-544-4600
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Fax | 623-544-4725
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALBERT CLARK RUTTINGER
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Credential | D.O.
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Telephone | 623-544-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 2607
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License Number State | AZ
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