Provider Demographics
NPI:1255307260
Name:RUGGERI, AMY H (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:RUGGERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JAYNES
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 E THOMAS ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3204
Mailing Address - Country:US
Mailing Address - Phone:860-678-3402
Mailing Address - Fax:844-364-3181
Practice Address - Street 1:3815 S. VAL VISTA DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7309
Practice Address - Country:US
Practice Address - Phone:480-782-0993
Practice Address - Fax:833-337-0386
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8J10207V00000X
AZ63730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1255307260Medicaid
E84208Medicare UPIN
MO152800003Medicare PIN