Provider Demographics
NPI:1669495172
Name:RUTLEDGE, NICHOLAS WARD (DPM)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:WARD
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:DPM
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 99
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-0099
Mailing Address - Country:US
Mailing Address - Phone:772-569-0081
Mailing Address - Fax:772-569-0819
Practice Address - Street 1:1880 37TH STREET, SUITE 4
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4502
Practice Address - Country:US
Practice Address - Phone:772-569-0081
Practice Address - Fax:772-569-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02624213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65519OtherBCBS
FL65519OtherBCBS
FL65519AMedicare ID - Type Unspecified