Provider Demographics
NPI:1629068390
Name:RUGGIERO, SHARON J (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:WIDSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114097OtherFIRST HEALTH PLAN
602565000OtherMEDICAL ASSISTANCE MA
110916OtherUCARE
600824OtherARAZ GROUP AMERICAS PPO
986027OtherPREFERRED ONE
0429560OtherMEDICA HEALTH PLANS
119001629OtherMEDICARE
6D086RUOtherBLUE CROSS BLUE SHIELD
HP22738OtherHEALTH PARTNERS
600824OtherARAZ GROUP AMERICAS PPO