Provider Demographics
NPI:1538182241
Name:RUCKLE, PATRICIA L (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:RUCKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SURF WAY APT 332
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3457
Mailing Address - Country:US
Mailing Address - Phone:831-643-0238
Mailing Address - Fax:
Practice Address - Street 1:1900 GARDEN RD STE 110
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5334
Practice Address - Country:US
Practice Address - Phone:831-643-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG510482080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine