Individual
DR. PAUL GEOFFREY RUTLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12812 TESSON FERRY RD, SAINT LOUIS, MO 63128-2913
(314) 722-2862
(314) 722-2852
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 722-2862
(314) 722-2852
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-113309
IL
207Q00000X
Family Medicine Physician
036-113309
IL
207Q00000X
Family Medicine Physician
Primary
2003023209
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008232163
BLUECROSS BLUESHIELD
IL
05
—
036113309
—
IL
01
—
08232205
BLUE CROSS BLUE SHIELD
IL
05
—
209084607
—
MO
Enumeration date
08/03/2006
Last updated
02/19/2015
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