Ralph H. Ruckle, MD
Organization Active NPI Family Medicine Physician · Portland, TN
NPI 1841491990 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1841491990
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD9576 (TN)
- Legal business name
- RALPH H. RUCKLE, MD
- Practice address
- 103 Redbud Dr
Suite C
Portland, TN 37148-1617 - Phone
- (615) 325-7337
- Fax
- (615) 325-0164
- NPI assigned
- May 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Ralph H. Ruckle, MD
- Title
- Owner
- Phone
- (615) 325-7337
National Provider Directory
Locations
103 Redbud Dr
Ste C
Portland, TN 37148
Phone (615) 325-7337
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | MD9576 | TN | Yes |
Addresses
Primary practice location
103 Redbud Dr
Suite C
Portland, TN 37148-1617
Mailing address
103 Redbud Dr
Suite C
Portland, TN 37148-1617
Phone (615) 325-7337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3160017 | Medicaid | TN |
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All providers in Portland, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.