Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016003701 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016003701 | IL |
NPI | 1366440166 |
---|---|
Provider Name | Dr. John Daniel Ruff |
First Address | Peoria, IL 61603-4133 |
Second Address | Peoria, IL 61603-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 24/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003701 | (05) | IL |
1386802775 | CENTRAL ILLINOIS NERVE TESTING LTD (01) | IL |
1588813133 | -ASSOCIATE RACHEL GRIEDER DPM (01) | IL |
1588813133 | PEORIA PODIATRY GROUP PC (01) | IL |
T38405 | (02) | IL |