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NPI Code Detail

MEDICARE: MR. MITCHELL CLARK RUFFCORN MD

MEDICARE: MR. MITCHELL CLARK RUFFCORN 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
1207L00000XAnesthesiology Physician20171IA

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 : 1619953957
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MITCHELL CLARK RUFFCORN MD
Provider Business Mailing Address
First Line : PO BOX 2441
Second Line :
City : DAVENPORT
State : IA
Zip : 52809-2441
Country : US
Telephone Number : 563-324-8160
Fax Number : 563-324-8486
Provider Business Practice Location Address
First Line : 1227 E RUSHOLME ST
Second Line :
City : DAVENPORT
State : IA
Zip : 52803-2459
Country : US
Telephone Number : 563-421-1000
Fax Number : 563-421-7889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 07/08/2007

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Directions to “ MR. MITCHELL CLARK RUFFCORN MD” Practice Location

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