=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902081136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY C RUGGEROLI MD LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2008
-----------------------------------------------------
Last Update Date | 04/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6070 S FORT APACHE RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-307-7700
-----------------------------------------------------
Fax | 702-307-7942
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 370427
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89137-0427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-307-7700
-----------------------------------------------------
Fax | 702-307-7942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/PRESIDENT
-----------------------------------------------------
Name | ANTHONY CHARLES RUGGEROLI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 702-307-7700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 8127
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------