Provider Demographics
NPI:1982022034
Name:RUTLEDGE, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 GARNER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4809
Mailing Address - Country:US
Mailing Address - Phone:830-278-6251
Mailing Address - Fax:830-591-0263
Practice Address - Street 1:1025 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4809
Practice Address - Country:US
Practice Address - Phone:830-278-6251
Practice Address - Fax:830-591-0263
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740288505OtherHOSPITAL