Basic Information
| Provider Information | |||||||||
| NPI: | 1477529139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUFF | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 NW EXPRESSWAY | ||||||||
| Address2: | SUITE 610 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052869465 | ||||||||
| FaxNumber: | 4052869462 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S DOUGLAS BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731305251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057333030 | ||||||||
| FaxNumber: | 4057333865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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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 | 208600000X | 20876 | OK | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100046880A | 05 | OK | MEDICAID |