Provider Demographics
NPI:1801916556
Name:RUTTLE, MICHAEL ROBERT (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:RUTTLE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:18335 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-3217
Mailing Address - Country:US
Mailing Address - Phone:936-291-3219
Mailing Address - Fax:936-291-7206
Practice Address - Street 1:2507 LAKE RD # 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5735
Practice Address - Country:US
Practice Address - Phone:936-291-3219
Practice Address - Fax:936-291-7206
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00723363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical