Provider Demographics
NPI:1487738308
Name:RUCKER, GAIL MONICA (DPM)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:MONICA
Last Name:RUCKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 ESTATE THOMAS
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3641
Mailing Address - Country:US
Mailing Address - Phone:340-779-2663
Mailing Address - Fax:340-779-2443
Practice Address - Street 1:9151 ESTATE THOMAS STE 206
Practice Address - Street 2:FOOTHILLS PROFESSIONAL BLDG.
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3634
Practice Address - Country:US
Practice Address - Phone:340-779-2663
Practice Address - Fax:340-779-2443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1475213ES0103X
DCPO445213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIFC992XMedicare UPIN