Provider Demographics
NPI:1164637294
Name:RUTLEDGE, ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 CONFIDENT CREST CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5905
Mailing Address - Country:US
Mailing Address - Phone:702-215-9550
Mailing Address - Fax:702-456-1173
Practice Address - Street 1:98 E LAKE MEAD PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5540
Practice Address - Country:US
Practice Address - Phone:702-456-4643
Practice Address - Fax:702-456-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100741Medicare UPIN