Basic Information
| Provider Information | |||||||||
| NPI: | 1417927922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUGG | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3617 S PACIFIC HWY | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975018957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416903600 | ||||||||
| FaxNumber: | 5416643735 | ||||||||
| Practice Location | |||||||||
| Address1: | 4940 HAMRICK RD | ||||||||
| Address2: | |||||||||
| City: | CENTRAL POINT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975023072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416903600 | ||||||||
| FaxNumber: | 5416643735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 01/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA 16471 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA169785 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 16471 | 01 | CA | PHYSICIAN ASSISTANT | OTHER | PA169785 | 01 | OR | OR PA LICENSE | OTHER |