Provider Demographics
NPI:1992268684
Name:RUFFCORN, MEGAN CATHERINE (DO)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CATHERINE
Last Name:RUFFCORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:CATHERINE
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:71 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:DEADWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57732-1303
Mailing Address - Country:US
Mailing Address - Phone:605-717-6431
Mailing Address - Fax:
Practice Address - Street 1:71 CHARLES ST
Practice Address - Street 2:
Practice Address - City:DEADWOOD
Practice Address - State:SD
Practice Address - Zip Code:57732-1303
Practice Address - Country:US
Practice Address - Phone:605-717-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD13589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program