Provider Demographics
NPI:1275284960
Name:RUYLE, BENJAMIN L (MED)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:L
Last Name:RUYLE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E HAZEL DELL LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-4210
Mailing Address - Country:US
Mailing Address - Phone:217-585-5437
Mailing Address - Fax:
Practice Address - Street 1:15 E HAZEL DELL LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712-4210
Practice Address - Country:US
Practice Address - Phone:217-585-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator