Basic Information
Provider Information | |||||||||
NPI: | 1942425459 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RULEWICZ | ||||||||
FirstName: | GABRIEL | ||||||||
MiddleName: | JOB | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4381 S EASON BLVD | ||||||||
Address2: | SUITE 303 | ||||||||
City: | TUPELO | ||||||||
State: | MS | ||||||||
PostalCode: | 388016583 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6628405747 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 499 GLOSTER CREEK VLG STE G1 | ||||||||
Address2: |   | ||||||||
City: | TUPELO | ||||||||
State: | MS | ||||||||
PostalCode: | 388014751 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6623772663 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2007 | ||||||||
LastUpdateDate: | 12/07/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/07/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 18612 | MS | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 18612 | MS | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.