Provider Demographics
NPI:1851442248
Name:RUCKMAN, DOUGLAS JAMES (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAMES
Last Name:RUCKMAN
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:PO BOX 8309
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8309
Mailing Address - Country:US
Mailing Address - Phone:800-811-6964
Mailing Address - Fax:562-468-0347
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2390
Practice Address - Fax:231-845-2240
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016187207P00000X
IN02006303A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82396Medicare UPIN
MIP17710016Medicare PIN