Provider Demographics
NPI:1295170850
Name:RUFFY, RODOLPHE (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLPHE
Middle Name:
Last Name:RUFFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 S PARK TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3417
Mailing Address - Country:US
Mailing Address - Phone:801-278-6154
Mailing Address - Fax:
Practice Address - Street 1:4228 S PARK TERRACE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3417
Practice Address - Country:US
Practice Address - Phone:801-278-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181594-8905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist