Provider Demographics
NPI:1033570809
Name:DR. RALPH H. RUSCO JR.
Entity Type:Organization
Organization Name:DR. RALPH H. RUSCO JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:RUSCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:941-488-8862
Mailing Address - Street 1:807 US HIGHWAY 41 BYP S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4360
Mailing Address - Country:US
Mailing Address - Phone:941-488-8862
Mailing Address - Fax:941-485-4066
Practice Address - Street 1:807 US HIGHWAY 41 BYP S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4360
Practice Address - Country:US
Practice Address - Phone:941-488-8862
Practice Address - Fax:941-485-4066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. RALPH H. RUSCO JR.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S0002193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82927Medicare PIN