Provider Demographics
NPI:1316072697
Name:RYBKA, RUSSELL JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JOHN
Last Name:RYBKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MAIN ST
Mailing Address - Street 2:P.O. BOX 125
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3904
Mailing Address - Country:US
Mailing Address - Phone:207-829-6463
Mailing Address - Fax:207-829-6513
Practice Address - Street 1:326 MAIN ST
Practice Address - Street 2:125
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-3904
Practice Address - Country:US
Practice Address - Phone:207-829-6463
Practice Address - Fax:207-829-6513
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME233213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
037988OtherANTHEM
U28405Medicare UPIN
MM4095Medicare ID - Type Unspecified