Provider Demographics
NPI:1588681183
Name:RUTLEDGE, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-263-3702
Practice Address - Street 1:7201 HAWKINS VIEW DR STE 151
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3934
Practice Address - Country:US
Practice Address - Phone:817-263-7200
Practice Address - Fax:817-377-6558
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8751208600000X
WI2316208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155123601Medicaid
020054589OtherRAILROAD MEDICARE
020054589OtherRAILROAD MEDICARE
G92711Medicare UPIN