Provider Demographics
NPI:1932170966
Name:RUZICKA, DOUGLAS F (PA-C)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:F
Last Name:RUZICKA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-1221
Mailing Address - Country:US
Mailing Address - Phone:402-729-3361
Mailing Address - Fax:
Practice Address - Street 1:825 22ND ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-1221
Practice Address - Country:US
Practice Address - Phone:402-729-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE269000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE87050RUMedicare ID - Type Unspecified
NER80744Medicare UPIN