Provider Demographics
NPI:1922847656
Name:RUFFIN, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SHED RD STE D2
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3386
Mailing Address - Country:US
Mailing Address - Phone:318-412-6720
Mailing Address - Fax:318-230-7788
Practice Address - Street 1:2750 SHED RD D2
Practice Address - Street 2:
Practice Address - City:BOSSIER
Practice Address - State:LA
Practice Address - Zip Code:71067
Practice Address - Country:US
Practice Address - Phone:318-412-6720
Practice Address - Fax:318-230-7788
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center