1487738308 NPI number — DR. GAIL MONICA RUCKER D.P.M.

Table of content: KAREN ADAMS N.P. (NPI 1497113344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487738308 NPI number — DR. GAIL MONICA RUCKER D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUCKER
Provider First Name:
GAIL
Provider Middle Name:
MONICA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487738308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9160 ESTATE THOMAS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00802-3641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-779-2663
Provider Business Mailing Address Fax Number:
340-779-2443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9151 ESTATE THOMAS STE 206
Provider Second Line Business Practice Location Address:
FOOTHILLS PROFESSIONAL BLDG.
Provider Business Practice Location Address City Name:
ST THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-779-2663
Provider Business Practice Location Address Fax Number:
340-779-2443
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  1475 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: PO445 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)