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NPI Code Detail

MEDICARE: J D RUGGIERO MD PLLC

MEDICARE: J D RUGGIERO MD PLLC
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
1207YX0905XOtolaryngology/Facial Plastic Surgery PhysicianFL

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 : 1912912106
Entity Type Code : Organization
Provider Name (Legal Business Name) : J D RUGGIERO MD PLLC
Provider Business Mailing Address
First Line : 2035 PROFESSIONAL CENTER DR STE A
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4462
Country : US
Telephone Number : 904-579-4692
Fax Number : 904-639-6002
Provider Business Practice Location Address
First Line : 2035 PROFESSIONAL CENTER DR
Second Line : SUITE A
City : ORANGE PARK
State : FL
Zip : 32073-4492
Country : US
Telephone Number : 904-272-3200
Fax Number : 904-272-3211
Authorized Official
Title or Position : OWNER
Name : DR. JOSEPH DAVID RUGGIERO
Credential : MD
Telephone Number : 904-834-1002
Provider Enumeration Date : 07/29/2006
Last Update Date : 02/23/2021

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