Provider Demographics
NPI:1417927922
Name:RUGG, ELIZABETH ANN (PA, NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:RUGG
Suffix:
Gender:F
Credentials:PA, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-8957
Mailing Address - Country:US
Mailing Address - Phone:541-690-3600
Mailing Address - Fax:541-664-3735
Practice Address - Street 1:4940 HAMRICK RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-3072
Practice Address - Country:US
Practice Address - Phone:541-690-3600
Practice Address - Fax:541-664-3735
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16471363AM0700X
ORPA169785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16471OtherPHYSICIAN ASSISTANT
ORPA169785OtherOR PA LICENSE