Individual
JACOB AUSTIN RUZICKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19646 E 140TH ST S, BROKEN ARROW, OK 74014-4555
(918) 260-5920
Mailing address
7 RIVER RIDGE RD, BROKEN ARROW, OK 74014-4502
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
38921
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2019
Last updated
06/30/2022
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