Provider Demographics
NPI:1629009089
Name:RUCKER, GEORGE BINO (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:BINO
Last Name:RUCKER
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 1:6124 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9707
Mailing Address - Country:US
Mailing Address - Phone:941-448-1199
Mailing Address - Fax:941-462-1796
Practice Address - Street 1:6124 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9707
Practice Address - Country:US
Practice Address - Phone:941-448-1199
Practice Address - Fax:941-462-1796
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0082623208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01927XMedicare ID - Type Unspecified
FLH46272Medicare UPIN