Provider Demographics
NPI:1659317915
Name:RUTLEDGE, FRANKLIN ALLEN II (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:ALLEN
Last Name:RUTLEDGE
Suffix:II
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:PO BOX 1865
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1865
Mailing Address - Country:US
Mailing Address - Phone:760-646-8540
Mailing Address - Fax:887-304-0588
Practice Address - Street 1:12637 HESPERIA RD
Practice Address - Street 2:STE B
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7774
Practice Address - Country:US
Practice Address - Phone:760-646-8540
Practice Address - Fax:887-304-0588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60929208600000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G609290Medicaid
E56215Medicare UPIN
CA00G609290Medicare ID - Type Unspecified