Provider Demographics
NPI:1558628180
Name:RUCKERT, GUSTAVE THEODORE V (DO)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVE
Middle Name:THEODORE
Last Name:RUCKERT
Suffix:V
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:21 WILLOW POND WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-697-3201
Mailing Address - Fax:585-641-0388
Practice Address - Street 1:21 WILLOW POND WAY STE 100
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-641-0399
Practice Address - Fax:585-641-0388
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY283516207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology