Provider Demographics
NPI:1205105939
Name:FOOT & ANKLE SPECIALISTS OF JACKSONVILLE, INC.
Entity type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS OF JACKSONVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUCKH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-619-9338
Mailing Address - Street 1:3890 DUNN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6428
Mailing Address - Country:US
Mailing Address - Phone:904-619-9338
Mailing Address - Fax:904-619-9677
Practice Address - Street 1:3890 DUNN AVE
Practice Address - Street 2:STE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6428
Practice Address - Country:US
Practice Address - Phone:904-619-9338
Practice Address - Fax:904-619-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3048213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU96342Medicare UPIN
FL65809AMedicare PIN