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Individual

GUY H. J. RUDDICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
3231 S NATIONAL AVE, SPRINGFIELD, MO 65807-7304
(417) 888-5666
(417) 890-4174
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2000161005
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
426004305
MO
01
82290
AR BLUE SHIELD #
MO
Enumeration date
02/06/2007
Last updated
07/22/2008
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