Provider Demographics
NPI:1821087834
Name:RUCKMAN, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:RUCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3175
Mailing Address - Country:US
Mailing Address - Phone:936-634-8434
Mailing Address - Fax:936-639-2581
Practice Address - Street 1:2 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3175
Practice Address - Country:US
Practice Address - Phone:936-634-8434
Practice Address - Fax:936-639-2581
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120066901Medicaid
TX120066901Medicaid
TX87G081Medicare PIN