MEDICARE: DIRK D RUFFIN M.D.

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	G48041	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G48041	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1467496778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIRK D RUFFIN M.D.

Provider Business Mailing Address
First Line	:	26516 CRENSHAW BLVD
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-3970
Country	:	US
Telephone Number	:	310-541-7911
Fax Number	:	310-541-2953

Provider Business Practice Location Address
First Line	:	26516 CRENSHAW BLVD
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-3970
Country	:	US
Telephone Number	:	310-541-7911
Fax Number	:	310-541-2953

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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