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General NPI Number Information
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NPI Number | 1497199400
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Entity Type | Individual
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Provider Name | JESSICA JACKSON RUEB M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2013
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 115 MIDLANDS CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3456
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Country | US
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Telephone | 803-457-7000
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Fax | 803-457-7001
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Provider Business Mailing Address
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Address Line | 115 MIDLANDS CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3456
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Country | US
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Telephone | 803-312-4814
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Fax | 803-457-7001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number | 35134272
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License Number State | OH
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