Provider Demographics
NPI:1346221348
Name:RUGGIERO, J D (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:D
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2035 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4492
Mailing Address - Country:US
Mailing Address - Phone:904-272-3200
Mailing Address - Fax:904-272-3211
Practice Address - Street 1:2035 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4492
Practice Address - Country:US
Practice Address - Phone:904-272-3200
Practice Address - Fax:904-272-3211
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME67983207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16248ZMedicare PIN
I38841Medicare UPIN
FL16248Medicare PIN