Basic Information
| Provider Information | |||||||||
| NPI: | 1750744405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANDREW J RUFFETT PHD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17809 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322457809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047235665 | ||||||||
| FaxNumber: | 9043380951 | ||||||||
| Practice Location | |||||||||
| Address1: | 11869 CURLEW WAY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322231939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046131450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 08/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | RUFFETT | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9046131450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PY0003395 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.