| Elleston Craig Rucker Llc | |
|
811 S Decatur Blvd Las Vegas NV 89107-3933 | |
| (702) 439-5283 | |
| Not Available |
| Full Name | Elleston Craig Rucker Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 811 S Decatur Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Elleston Craig Rucker (OWNER) |
| Authorized Official Contact | 7024395283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elleston Craig Rucker Llc 811 S Decatur Blvd Las Vegas NV 89107-3933 Ph: (702) 439-5283 | Elleston Craig Rucker Llc 811 S Decatur Blvd Las Vegas NV 89107-3933 Ph: (702) 439-5283 |
| NPI Number | 1669969754 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 04/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669969754 | NPI | - | NPPES |
| 1679601470 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 6766 (Nevada) | Primary |
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