Provider Demographics
NPI:1366440166
Name:RUFF, JOHN DANIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:RUFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4133
Mailing Address - Country:US
Mailing Address - Phone:309-637-3668
Mailing Address - Fax:309-637-2325
Practice Address - Street 1:614 SPRING ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4133
Practice Address - Country:US
Practice Address - Phone:309-637-3668
Practice Address - Fax:309-637-2325
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003701213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003701Medicaid
IL1386802775OtherCENTRAL ILLINOIS NERVE TESTING LTD
IL1588813133OtherPEORIA PODIATRY GROUP PC
IL1588813133Other-ASSOCIATE RACHEL GRIEDER DPM
IL742741001Medicare PIN
IL1386802775OtherCENTRAL ILLINOIS NERVE TESTING LTD
IL1588813133OtherPEORIA PODIATRY GROUP PC