Provider Demographics
NPI:1578624060
Name:RUITER, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:RUITER
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 1:31194 ELEPHANT ROCK LN
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-9827
Mailing Address - Country:US
Mailing Address - Phone:719-395-8117
Mailing Address - Fax:
Practice Address - Street 1:1000 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9627
Practice Address - Country:US
Practice Address - Phone:719-530-2250
Practice Address - Fax:719-530-2239
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28964207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01289644Medicaid
CO01289644Medicaid
COC255048Medicare ID - Type Unspecified