Provider Demographics
NPI:1619174307
Name:RUCH, SHARON EVONNE (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:EVONNE
Last Name:RUCH
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 1:10620 S HIGHLANDS PKY
Mailing Address - Street 2:STE 110 155
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141
Mailing Address - Country:US
Mailing Address - Phone:702-754-5421
Mailing Address - Fax:775-312-2857
Practice Address - Street 1:10620 SOUTHERN HIGHLANDS PARKWAY
Practice Address - Street 2:STE 110-155
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141
Practice Address - Country:US
Practice Address - Phone:702-754-5421
Practice Address - Fax:775-312-2857
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV112386Medicare PIN