Provider Demographics
NPI:1376553008
Name:RUCKER, BURNETT (MD)
Entity Type:Individual
Prefix:
First Name:BURNETT
Middle Name:
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:PO BOX 82396
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93380-2396
Mailing Address - Country:US
Mailing Address - Phone:661-323-5918
Mailing Address - Fax:661-323-4703
Practice Address - Street 1:2615 EYE ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2006
Practice Address - Country:US
Practice Address - Phone:661-395-3000
Practice Address - Fax:661-323-4703
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A343490Medicaid
CACM536ZOtherMEDICARE PIN - WSUC
CA00A343490Medicare PIN
CACM536ZOtherMEDICARE PIN - WSUC