MEDICARE: MICHAEL F. RUGGIERO 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	H9144	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00J13Z	OTHER	TX	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700880051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL F. RUGGIERO D.O.

Provider Business Mailing Address
First Line	:	2310 DE LEE ST STE 200
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-774-0866
Fax Number	:	979-774-0937

Provider Business Practice Location Address
First Line	:	2310 DE LEE ST STE 200
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-774-0866
Fax Number	:	979-774-0937

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/25/2015

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