Provider Demographics
NPI:1174595797
Name:CHARLES W. RUGGLES, M.D.
Entity type:Organization
Organization Name:CHARLES W. RUGGLES, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-633-1725
Mailing Address - Street 1:3245 INTERNATIONAL CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3152
Mailing Address - Country:US
Mailing Address - Phone:719-633-1725
Mailing Address - Fax:719-633-7426
Practice Address - Street 1:3245 INTERNATIONAL CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3152
Practice Address - Country:US
Practice Address - Phone:719-633-1725
Practice Address - Fax:719-633-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19699174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19699OtherLICENSE
KS04-15064OtherLICENSE