Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2016022707 | MO |
Y | 207P00000X | Emergency Physician | 35.140243 | OH |
NPI | 1013369040 |
---|---|
Provider Name | Dr. Laura Ruble |
First Address | Traverse City, MI 49684 |
Second Address | Woodbury, NJ 08096-2739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2016 |
Last Update Date | 18/06/2021 |