MEDICARE: ROBERTA W RUGGERI D.O.

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
1	207Q00000X	Family Medicine Physician	DO21865	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080175728	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	275744501	OTHER	OR	CIGNA
2	A006	OTHER	OR	TRICARE
3	7471260	OTHER	OR	AETNA INS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	067039108	OTHER	OR	REGENCE BLUE CROSS

General Provider Information

NPI Number	:	1396735254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA W RUGGERI D.O.

Provider Business Mailing Address
First Line	:	2250 SE OAKGROVE BLVD
Second Line	:	SUITEB
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2659
Country	:	US
Telephone Number	:	503-654-6567
Fax Number	:	503-653-2582

Provider Business Practice Location Address
First Line	:	2250 SE OAKGROVE BLVD
Second Line	:	SUITE B
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2659
Country	:	US
Telephone Number	:	503-654-6567
Fax Number	:	503-653-2582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/23/2022

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Directions to “ ROBERTA W RUGGERI D.O.” Practice Location

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