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NPI Code Detail

MEDICARE: DR. WILDER SHAWN RUCKER MD

MEDICARE: DR. WILDER SHAWN RUCKER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician264414NY
2208D00000XGeneral Practice Physician000-26-4414NY
3207Q00000XFamily Medicine Physician264414NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235403742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILDER SHAWN RUCKER MD
Provider Business Mailing Address
First Line : 1276 DEKALB AVE # 4A
Second Line :
City : BROOKLYN
State : NY
Zip : 11221-3204
Country : US
Telephone Number : 718-490-0738
Fax Number :
Provider Business Practice Location Address
First Line : 3601 SW 160TH AVE STE 250
Second Line :
City : MIRAMAR
State : FL
Zip : 33027-6314
Country : US
Telephone Number : 877-866-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2012
Last Update Date : 03/13/2026

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