Provider Demographics
NPI:1558378315
Name:RUUD, REBECCA T (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:T
Last Name:RUUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MINOR AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2120
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-386-9605
Practice Address - Street 1:1200 112TH AVE NE
Practice Address - Street 2:B250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3732
Practice Address - Country:US
Practice Address - Phone:425-462-1132
Practice Address - Fax:425-456-3668
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA254259OtherLNI
WA1019RUOtherREGENCE
WAP00833911OtherPALMETTO / RR MEDICARE
WA8195265Medicaid
WAP00833911OtherPALMETTO / RR MEDICARE
WAG27540Medicare UPIN
WAG8858495Medicare PIN