Provider Demographics
NPI:1043677784
Name:SHARON E RUCH MD PLLC
Entity Type:Organization
Organization Name:SHARON E RUCH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-614-1250
Mailing Address - Street 1:10604 SAN BELLACOVA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3985
Mailing Address - Country:US
Mailing Address - Phone:702-614-1250
Mailing Address - Fax:949-215-5044
Practice Address - Street 1:10604 SAN BELLACOVA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3985
Practice Address - Country:US
Practice Address - Phone:702-614-1250
Practice Address - Fax:949-215-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12553OtherLICENCE