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General NPI Number Information
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NPI Number | 1952564882
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Entity Type | Individual
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Provider Name | WILLIAM CLINTON RUFFIAN III PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 1510 E ARLINGTON BLVD STE B
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City | GREENVILLE
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State | NC
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Zip | 27858-5348
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Country | US
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Telephone | 252-375-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 CADENZA CT
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City | GREENVILLE
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State | NC
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Zip | 27858-6032
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Country | US
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Telephone | 336-906-0319
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-01290
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01290
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License Number State | NC
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