Provider Demographics
NPI:1750709523
Name:RUTLEDGE, JOSEPH CLAYTON (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CLAYTON
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29943 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:317-706-7246
Mailing Address - Fax:
Practice Address - Street 1:3750 LANDMARK DR STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6652
Practice Address - Country:US
Practice Address - Phone:317-706-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083876A207LP2900X, 208VP0014X, 208VP0014X
IN99098179A207L00000X
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program