Provider Demographics
NPI:1851352082
Name:RUCKH, EUGENE E (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:E
Last Name:RUCKH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 DUNN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6428
Mailing Address - Country:US
Mailing Address - Phone:904-619-9338
Mailing Address - Fax:904-619-9677
Practice Address - Street 1:3890 DUNN AVE
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6428
Practice Address - Country:US
Practice Address - Phone:904-619-9338
Practice Address - Fax:904-619-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3048213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
65809YMedicare PIN
65809AMedicare PIN
FL65809WMedicare PIN
FLU96342Medicare UPIN
FL65809XMedicare PIN