Provider Demographics
NPI:1841405883
Name:RUEGSEGGER, CAROLE SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:SUZANNE
Last Name:RUEGSEGGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3750 E COUNTRY FIELD CIR
Mailing Address - Street 2:UNIT B
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6689
Mailing Address - Country:US
Mailing Address - Phone:907-357-7240
Mailing Address - Fax:907-357-7241
Practice Address - Street 1:3750 E COUNTRY FIELD CIR
Practice Address - Street 2:UNIT B
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6689
Practice Address - Country:US
Practice Address - Phone:907-357-7240
Practice Address - Fax:907-357-7241
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45330OtherMEDICAL LICENSE