Provider Demographics
NPI:1326034513
Name:RUCKER, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:RUCKER
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 1:4433 NORRIS STORE RD
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-8725
Mailing Address - Country:US
Mailing Address - Phone:252-746-3884
Mailing Address - Fax:
Practice Address - Street 1:130 GLENDALE DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2770
Practice Address - Country:US
Practice Address - Phone:252-399-7557
Practice Address - Fax:252-399-1324
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26867208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973822Medicaid
NC8973822Medicaid
210072BMedicare ID - Type Unspecified