Provider Demographics
NPI:1578695599
Name:ROBERT G RUEGG MD PC
Entity Type:Organization
Organization Name:ROBERT G RUEGG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RUEGG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-467-4016
Mailing Address - Street 1:9862 QUAY WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5419
Mailing Address - Country:US
Mailing Address - Phone:303-467-4016
Mailing Address - Fax:
Practice Address - Street 1:3400 LUTHERAN PKWY
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6035
Practice Address - Country:US
Practice Address - Phone:303-467-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO196972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0119697Medicaid
COD92787Medicare UPIN
CO0119697Medicaid