Provider Demographics
NPI:1891702965
Name:RUGGIERI, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RUGGIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 W MARION AVE
Mailing Address - Street 2:116
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5372
Mailing Address - Country:US
Mailing Address - Phone:941-629-4500
Mailing Address - Fax:941-639-7576
Practice Address - Street 1:1107 W MARION AVE
Practice Address - Street 2:116
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5372
Practice Address - Country:US
Practice Address - Phone:941-629-4500
Practice Address - Fax:941-639-7576
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0055973207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
592171328-001OtherCHAMPUS/TRICARE
FL063839100Medicaid
280546OtherWELLCARE
5313726001OtherCIGNA
060013311OtherRAILROAD MEDICARE
2101034OtherGHI
4602371OtherAETNA
FL10307OtherBLUE SHIELD
FL10307OtherBLUE SHIELD
4602371OtherAETNA