Provider Demographics
NPI:1477529139
Name:RUFF, THEODORE A (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:A
Last Name:RUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 610
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-286-9465
Mailing Address - Fax:405-286-9462
Practice Address - Street 1:1001 S DOUGLAS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5251
Practice Address - Country:US
Practice Address - Phone:405-733-3030
Practice Address - Fax:405-733-3865
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20876208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100046880AMedicaid
OK$$$$$$$$$003OtherBCBS
OKP00207735Medicare PIN
OK$$$$$$$$$003OtherBCBS
OK100046880AMedicaid