Provider Demographics
NPI:1265798912
Name:RUTHPRO INCORPORATED
Entity type:Organization
Organization Name:RUTHPRO INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PROPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-570-4011
Mailing Address - Street 1:16306 BRAEBURN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-9508
Mailing Address - Country:US
Mailing Address - Phone:561-638-1778
Mailing Address - Fax:954-570-6728
Practice Address - Street 1:5300 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4395
Practice Address - Country:US
Practice Address - Phone:954-570-4011
Practice Address - Fax:954-570-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID#