Individual
DR. PHILLIP J RUFFALO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1213 15TH AVE W, SUITE 250, WILLISTON, ND 58801-3800
(701) 577-0319
(701) 572-7438
Mailing address
1213 15TH AVE W, SUITE 250, WILLISTON, ND 58801-3800
(701) 577-0319
(701) 572-7438
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
3813
MT
208600000X
Surgery Physician
M5897
ID
208600000X
Surgery Physician
Primary
ND3055
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031720
MT MEDICAID
MT
05
—
013760
—
ND
01
—
3813
MT LICENSE #
MT
01
—
594
ND BLUE CROSS BLUE SHIELD
ND
01
—
M5897
IDAHO LICENSE #
ID
Enumeration date
11/16/2005
Last updated
07/08/2007
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