Provider Demographics
NPI:1972629970
Name:RUFFNER, THOMAS JEFFREY (SFIDC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEFFREY
Last Name:RUFFNER
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 WIND CHASE DR
Mailing Address - Street 2:NMCB 133 GULFPORT, MS
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2299
Mailing Address - Country:US
Mailing Address - Phone:229-506-1022
Mailing Address - Fax:
Practice Address - Street 1:5503 MARVIN SHIELDS BLVD
Practice Address - Street 2:NHBC GULFPORT
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-9007
Practice Address - Country:US
Practice Address - Phone:228-871-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman