Individual
SHANE RUCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 SPRUCE ST, 2 CATHCART, PHILADELPHIA, PA 19107-6130
(215) 829-3264
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
241661
NY
207P00000X
Emergency Medicine Physician
4490
WI
207P00000X
Emergency Medicine Physician
Primary
MD067927L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001769535
—
PA
Enumeration date
07/10/2006
Last updated
07/23/2024
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