Provider Demographics
NPI:1740253434
Name:RUTTINGER, ALBERT CLARK (DO)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CLARK
Last Name:RUTTINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13951 W GRAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2436
Mailing Address - Country:US
Mailing Address - Phone:623-544-4600
Mailing Address - Fax:623-544-4725
Practice Address - Street 1:13951 W GRAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2436
Practice Address - Country:US
Practice Address - Phone:623-544-4600
Practice Address - Fax:623-544-4725
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2607207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2607OtherLICENSE NUMBER
AZ2607OtherLICENSE NUMBER
AZCO3206Medicare UPIN