Provider Demographics
NPI:1760884514
Name:RUEL, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 W LAKE MARY BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3581
Mailing Address - Country:US
Mailing Address - Phone:407-324-3655
Mailing Address - Fax:407-324-3656
Practice Address - Street 1:3224 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3581
Practice Address - Country:US
Practice Address - Phone:407-324-3655
Practice Address - Fax:407-324-3656
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT063.0000154237700000X
FLAS 5046237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist