Provider Demographics
NPI:1851602908
Name:RUCKER, EBONY (MD)
Entity Type:Individual
Prefix:DR
First Name:EBONY
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 ALABAMA ST
Mailing Address - Street 2:APT. 161
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2633
Mailing Address - Country:US
Mailing Address - Phone:313-942-5660
Mailing Address - Fax:
Practice Address - Street 1:5041 ALABAMA ST
Practice Address - Street 2:APT. 161
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2633
Practice Address - Country:US
Practice Address - Phone:313-942-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032960207P00000X
TXN7482207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine