Provider Demographics
NPI:1821142829
Name:RUTERBUSCH, JEFFREY ALLYN (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLYN
Last Name:RUTERBUSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PARKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7507
Mailing Address - Country:US
Mailing Address - Phone:904-589-0750
Mailing Address - Fax:904-375-8821
Practice Address - Street 1:316 PARKRIDGE AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7507
Practice Address - Country:US
Practice Address - Phone:904-589-0750
Practice Address - Fax:904-375-8821
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133N00000X
FLOS64032083P0901X, 204D00000X, 207QS0010X
FL0006403204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821142829OtherNPI
FL1841673928OtherGROUP NPI
FLIP327AOtherPTAN