Basic Information
| Provider Information | |||||||||
| NPI: | 1164467502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUEGG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 IRIS AVE | ||||||||
| Address2: | MHP | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034136212 | ||||||||
| FaxNumber: | 3034136325 | ||||||||
| Practice Location | |||||||||
| Address1: | 529 COFFMAN ST | ||||||||
| Address2: | #300 | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036840555 | ||||||||
| FaxNumber: | 9703365000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 03/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 19697 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 01196971 | 05 | CO | MEDICAID |