Provider Demographics
NPI:1700880051
Name:RUGGIERO, MICHAEL F (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 DE LEE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2815
Mailing Address - Country:US
Mailing Address - Phone:979-774-0866
Mailing Address - Fax:979-774-0937
Practice Address - Street 1:2310 DE LEE ST STE 200
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2815
Practice Address - Country:US
Practice Address - Phone:979-774-0866
Practice Address - Fax:979-774-0937
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J13ZOtherBLUE CROSS
TX133458308OtherTHSTEP - MEDICAID
TX160899401Medicaid
TX160899401Medicaid
TX160899401Medicaid