Provider Demographics
NPI:1922076090
Name:RUGGERI, SEBASTIAN B (MD)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:B
Last Name:RUGGERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3104 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:602-954-9484
Mailing Address - Fax:602-954-6433
Practice Address - Street 1:3104 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-954-9484
Practice Address - Fax:602-954-6433
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ124382086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229254Medicaid
860443722Medicare ID - Type Unspecified
E00176Medicare UPIN