Provider Demographics
NPI:1215933643
Name:RUCKER, JOSEPH W (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:RUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4398
Mailing Address - Country:US
Mailing Address - Phone:715-833-2116
Mailing Address - Fax:715-833-1068
Practice Address - Street 1:3221 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4398
Practice Address - Country:US
Practice Address - Phone:715-833-2116
Practice Address - Fax:715-833-1068
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1300044OtherMEDICA
WI30593200Medicaid
WI391528316014OtherBLUE CROSS OF WI
WI30593200Medicaid
WI000120060Medicare ID - Type UnspecifiedMEDICARE