Provider Demographics
NPI:1396735254
Name:RUGGERI, ROBERTA W (DO)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:W
Last Name:RUGGERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SE OAKGROVE BLVD
Mailing Address - Street 2:SUITEB
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2659
Mailing Address - Country:US
Mailing Address - Phone:503-654-6567
Mailing Address - Fax:503-653-2582
Practice Address - Street 1:2250 SE OAKGROVE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2659
Practice Address - Country:US
Practice Address - Phone:503-654-6567
Practice Address - Fax:503-653-2582
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO21865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275744501OtherCIGNA
ORA006OtherTRICARE
OR7471260OtherAETNA INS
OR080175728OtherRAILROAD MEDICARE
OR287646Medicaid
OR067039108OtherREGENCE BLUE CROSS
OR080175728OtherRAILROAD MEDICARE
R109739Medicare PIN
OR109739Medicare ID - Type Unspecified