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General NPI Number Information
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NPI Number | 1841491990
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Entity Type | Organization
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Legal Business Name | RALPH H. RUCKLE, MD
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 REDBUD DR SUITE C
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City | PORTLAND
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State | TN
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Zip | 37148-1617
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Country | US
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Telephone | 615-325-7337
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Fax | 615-325-0164
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Provider Business Mailing Address
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Address Line | 103 REDBUD DR SUITE C
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City | PORTLAND
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State | TN
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Zip | 37148-1617
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Country | US
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Telephone | 615-325-7337
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Fax | 615-325-0164
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Authorized Official
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Title or Position | OWNER
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Name | RALPH H. RUCKLE
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Credential | MD
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Telephone | 615-325-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD9576
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License Number State | TN
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