Provider Demographics
NPI:1699778027
Name:RUGGIAN, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:RUGGIAN
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 1:782 E. PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-0000
Mailing Address - Country:US
Mailing Address - Phone:772-340-0923
Mailing Address - Fax:772-340-4462
Practice Address - Street 1:782 E. PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-0000
Practice Address - Country:US
Practice Address - Phone:772-340-0923
Practice Address - Fax:772-340-4462
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67996207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28228OtherBLUECROSS BLUESHIELD
FL28228OtherBLUECROSS BLUESHIELD