Provider Demographics
NPI:1215969878
Name:RUYLE, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:RUYLE
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 1:207 S CHEHALIS
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2945
Mailing Address - Country:US
Mailing Address - Phone:360-533-2020
Mailing Address - Fax:360-533-1978
Practice Address - Street 1:207 S CHEHALIS
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2945
Practice Address - Country:US
Practice Address - Phone:360-533-2020
Practice Address - Fax:360-533-1978
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000028344207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1088558Medicaid
WA180032302OtherRAILROAD MEDICARE
WA124458OtherWA STATE LABOR & INDUST.
WA1246640001OtherCIGNA MEDICARE
WARU5893OtherREGENCE BLUE SHIELD
WAGAB04444Medicare PIN
WA124458OtherWA STATE LABOR & INDUST.