Individual
RUSKIN R LINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 N GILBERT RD, SUITE 206, GILBERT, AZ 85234-2390
(480) 507-7767
(480) 507-7793
Mailing address
660 N GILBERT RD, GILBERT, AZ 85234-3392
(480) 507-7767
(480) 507-7793
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
26848
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086985
—
AZ
01
—
AZ0855820
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
09/22/2005
Last updated
03/29/2016
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