Provider Demographics
NPI:1740366236
Name:RUETER, DAVID JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:RUETER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 BEAR VALLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5406
Mailing Address - Country:US
Mailing Address - Phone:949-833-3406
Mailing Address - Fax:
Practice Address - Street 1:18952 MACARTHUR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1401
Practice Address - Country:US
Practice Address - Phone:949-833-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE20470213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001960Medicaid
CAP00405925OtherRR MEDICARE
CAT11154Medicare UPIN
CA000E20472Medicare PIN
CA000E23170Medicare ID - Type Unspecified