Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 0006403 | FL |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS6403 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | OS6403 | FL |
NPI | 1821142829 |
---|---|
Provider Name | Dr. Jeffrey Allyn Ruterbusch |
First Address | Orange Park, FL 32065-7507 |
Second Address | Orange Park, FL 32065-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1821142829 | NPI (01) | FL |
1841673928 | GROUP NPI (01) | FL |