Provider Demographics
NPI:1659477685
Name:RUCKER, RICHARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
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 1:10931 CHERRY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2445
Mailing Address - Country:US
Mailing Address - Phone:562-596-2246
Mailing Address - Fax:562-799-0845
Practice Address - Street 1:10931 CHERRY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2445
Practice Address - Country:US
Practice Address - Phone:562-596-2246
Practice Address - Fax:562-799-0845
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61070207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610700Medicaid
WG61070DMedicare ID - Type Unspecified
E87049Medicare UPIN
WG61070CMedicare ID - Type Unspecified