Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1407 | OR |
NPI | 1073673497 |
---|---|
Provider Name | Dr. Tom Ruckman |
First Address | Eugene, OR 97401-7078 |
Second Address | Springfield, OR 97477-2188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |