Individual
DR. CREED MONROE RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Mailing address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Taxonomy
Speciality
Code
Description
License number
State
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
36409
AZ
2085N0700X
Neuroradiology Physician
36409
AZ
2085R0202X
Diagnostic Radiology Physician
36073
TN
2085R0202X
Diagnostic Radiology Physician
Primary
36409
AZ
2085R0204X
Vascular & Interventional Radiology Physician
ME147128
FL
2085U0001X
Diagnostic Ultrasound Physician
36409
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005472
GROUP MEDICAID ID
AZ
05
—
121242800
—
FL
01
—
1760428312
PHYSICIAN INDIVIDUAL NPI
AZ
05
—
185947
—
AZ
01
—
CS7943
GROUP MEDICARE RAILROAD ID & PTAN
AZ
01
—
P01479085
PHYSICIAN MEDICARE RAILROAD PTAN
AZ
01
—
ZWCBBM
GROUP MEDICARE ID
AZ
Enumeration date
06/21/2006
Last updated
05/08/2025
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