Provider Demographics
NPI:1780610832
Name:RUEL, THEODORE D (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:D
Last Name:RUEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:MAIL STOP 6E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8631
Mailing Address - Fax:415-206-3686
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:MAIL STOP 6E
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8631
Practice Address - Fax:415-206-3686
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA78286208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A782860Medicaid
CA00A782860Medicaid
CA00A782860Medicare PIN