Provider Demographics
NPI:1235793431
Name:RUSKIN, FREDERIC LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:LEONARD
Last Name:RUSKIN
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 1:7528 N CLEARWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2804
Mailing Address - Country:US
Mailing Address - Phone:602-689-8533
Mailing Address - Fax:
Practice Address - Street 1:7528 N CLEARWATER PKWY
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2804
Practice Address - Country:US
Practice Address - Phone:602-689-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9775207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology