Individual
MR. BENJAMIN LAVAR RUCKER JR.
Active
Individual
MR. BENJAMIN LAVAR RUCKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
017877
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000153139-B
—
GA
01
—
010270
BCBS
—
01
—
0400527
UNITED HEALTHCARE
—
01
—
581476757
COMMERCIAL
—
01
—
G17877
SC MEDICAID
—
Enumeration date
09/08/2006
Last updated
08/05/2011
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