Provider Demographics
NPI:1275705089
Name:MICHAEL F. RUGGIERO, DO, PA
Entity Type:Organization
Organization Name:MICHAEL F. RUGGIERO, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:979-774-0866
Mailing Address - Street 1:2901 E 29TH ST
Mailing Address - Street 2:SUITE 123
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 E 29TH ST
Practice Address - Street 2:SUITE 123
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2692
Practice Address - Country:US
Practice Address - Phone:979-774-0866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00145UMedicare PIN