Provider Demographics
NPI:1790770378
Name:RUCKLE, RALPH H (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:H
Last Name:RUCKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:103 REDBUD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1617
Mailing Address - Country:US
Mailing Address - Phone:615-325-7337
Mailing Address - Fax:615-325-0164
Practice Address - Street 1:103 REDBUD DR
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1617
Practice Address - Country:US
Practice Address - Phone:615-325-7337
Practice Address - Fax:615-325-0164
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD9576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2000371OtherBCBS OF TENNESSEE
TN2000371OtherBCBS OF TENNESSEE
TN3373288Medicare ID - Type Unspecified