Basic Information
Provider Information | |||||||||
NPI: | 1487738308 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RUCKER | ||||||||
FirstName: | GAIL | ||||||||
MiddleName: | MONICA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.P.M. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9160 ESTATE THOMAS | ||||||||
Address2: |   | ||||||||
City: | ST THOMAS | ||||||||
State: | VI | ||||||||
PostalCode: | 008023641 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3407792663 | ||||||||
FaxNumber: | 3407792443 | ||||||||
Practice Location | |||||||||
Address1: | 9151 ESTATE THOMAS STE 206 | ||||||||
Address2: | FOOTHILLS PROFESSIONAL BLDG. | ||||||||
City: | ST THOMAS | ||||||||
State: | VI | ||||||||
PostalCode: | 008023634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3407792663 | ||||||||
FaxNumber: | 3407792443 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/25/2006 | ||||||||
LastUpdateDate: | 09/27/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 1475 | VI | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | PO445 | DC | N |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
No ID Information.