Individual
JOHN P RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD ED.D.
Contact information
Practice address
6885 CLIFFDALE RD, FAYETTEVILLE, NC 28314-2833
(910) 339-0400
(910) 339-0396
Mailing address
6885 CLIFFDALE RD, FAYETTEVILLE, NC 28314-2833
(910) 339-0400
(910) 339-0396
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1230
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0384W
BSBCNC
NC
05
—
6000078
—
NC
01
—
680011983
RR MEDICARE
NC
Enumeration date
08/22/2005
Last updated
01/13/2012
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