Provider Demographics
NPI:1265422430
Name:RUCKER, ELSY (MD)
Entity type:Individual
Prefix:DR
First Name:ELSY
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9707
Mailing Address - Country:US
Mailing Address - Phone:941-727-1243
Mailing Address - Fax:941-739-6927
Practice Address - Street 1:6120 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9707
Practice Address - Country:US
Practice Address - Phone:941-727-1243
Practice Address - Fax:941-739-6927
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26623YMedicare PIN
FLB06492Medicare UPIN