Provider Demographics
NPI:1548656432
Name:RUGGIERO, GAETANO TREY III (MD)
Entity type:Individual
Prefix:
First Name:GAETANO
Middle Name:TREY
Last Name:RUGGIERO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:RUGGIERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8585 PICARDY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3748
Mailing Address - Country:US
Mailing Address - Phone:225-387-7918
Mailing Address - Fax:225-372-3717
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-763-4764
Practice Address - Fax:225-763-4549
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
LA309555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program