Active NPI
Paul Edward Ruttle, M.D.
- Specialist
- Jackson, WY
National Provider Identifier
1922545896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 3415A
- Practice address
- 2640 Trader Rd
Jackson, WY 83001-8321 - Phone
- (307) 413-6677
- NPI assigned
- Jan 30, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 3415A | WY | Primary |
Addresses
Primary practice location
2640 Trader Rd
Jackson, WY 83001-8321
Mailing address
PO Box 7471
Jackson, WY 83002-7471
Phone (307) 413-6677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3415A | WY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485734400000",
"number": "1922545896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7471",
"city": "JACKSON",
"state": "WY",
"postal_code": "830027471",
"telephone_number": "307-413-6677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2640 TRADER RD",
"city": "JACKSON",
"state": "WY",
"postal_code": "830018321",
"telephone_number": "307-413-6677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUTTLE",
"first_name": "PAUL",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-30",
"last_updated": "2017-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WY",
"license": "3415A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.