MEDICARE: DR. KEITH DOYLE 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
1	207P00000X	Emergency Medicine Physician	22469	IA

General Provider Information

NPI Number	:	1700877289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH DOYLE RUFFCORN MD

Provider Business Mailing Address
First Line	:	1229 S HILL DR
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50701-5046
Country	:	US
Telephone Number	:	319-235-6431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 LOGAN AVE
Second Line	:	EMERGENCY DEPARTMENT
City	:	WATERLOO
State	:	IA
Zip	:	50703-1916
Country	:	US
Telephone Number	:	319-235-3697
Fax Number	:	319-235-3844

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/19/2009

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