Provider Demographics
NPI:1497713101
Name:RUGGERO, ROQUE (MD)
Entity Type:Individual
Prefix:
First Name:ROQUE
Middle Name:
Last Name:RUGGERO
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 1:5102 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4734
Mailing Address - Country:US
Mailing Address - Phone:512-323-0069
Mailing Address - Fax:
Practice Address - Street 1:2400 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4004
Practice Address - Country:US
Practice Address - Phone:512-341-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0556207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142017602Medicaid
TX8A1511Medicare ID - Type Unspecified
TXH32720Medicare UPIN