Basic Information
| Provider Information | |||||||||
| NPI: | 1073132429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUCK | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | GIBSON | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 WALTON DR | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245022940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159734577 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 GOVERNORS DR SW RM 389 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565514543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2020 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.