Provider Demographics
NPI:1902948656
Name:RUCHALSKI, PAUL JOHN JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOHN
Last Name:RUCHALSKI
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5450 SEVENOAKS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-5410
Mailing Address - Country:US
Mailing Address - Phone:719-599-7134
Mailing Address - Fax:
Practice Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL USA MEDDAC
Practice Address - Street 2:DIRAIMONDO FAMILY MEDICINE CLINIC
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-524-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant