Basic Information
| Provider Information | |||||||||
| NPI: | 1891702965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUGGIERI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 W MARION AVE | ||||||||
| Address2: | 116 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339505372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416294500 | ||||||||
| FaxNumber: | 9416397576 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 W MARION AVE | ||||||||
| Address2: | 116 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339505372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416294500 | ||||||||
| FaxNumber: | 9416397576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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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 | 207RC0000X | ME-0055973 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 592171328-001 | 01 | CHAMPUS/TRICARE | OTHER | 063839100 | 05 | FL | MEDICAID | 280546 | 01 | WELLCARE | OTHER | 5313726001 | 01 | CIGNA | OTHER | 060013311 | 01 | RAILROAD MEDICARE | OTHER | 2101034 | 01 | GHI | OTHER | 4602371 | 01 | AETNA | OTHER | 10307 | 01 | FL | BLUE SHIELD | OTHER |