Provider Demographics
NPI:1194721522
Name:RUCKER, RAJIVI POTHIRAJ (MD)
Entity type:Individual
Prefix:DR
First Name:RAJIVI
Middle Name:POTHIRAJ
Last Name:RUCKER
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 1:1250 S TAMIAMI TRL STE 302
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2221
Mailing Address - Country:US
Mailing Address - Phone:941-877-5983
Mailing Address - Fax:941-957-0079
Practice Address - Street 1:1250 S TAMIAMI TRL STE 302
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2221
Practice Address - Country:US
Practice Address - Phone:941-877-5983
Practice Address - Fax:941-957-0079
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84160208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48958OtherFL BLUE
FLKI170OtherMEDICARE
FL004579100Medicaid