Individual
DR. WILDER SHAWN RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3601 SW 160TH AVE STE 250, MIRAMAR, FL 33027-6314
(877) 866-7123
Mailing address
1276 DEKALB AVE # 4A, BROOKLYN, NY 11221-3204
(718) 490-0738
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
264414
NY
208600000X
Surgery Physician
264414
NY
208D00000X
General Practice Physician
Primary
000-26-4414
NY
Other
Enumeration date
03/01/2012
Last updated
03/13/2026
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