Provider Demographics
NPI:1235294968
Name:RUARK, JOHN EDWARD (M D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:RUARK
Suffix:
Gender:M
Credentials:M D
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Mailing Address - Street 1:885 OAK GROVE AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-327-7100
Mailing Address - Fax:650-327-1420
Practice Address - Street 1:885 OAK GROVE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4433
Practice Address - Country:US
Practice Address - Phone:650-327-7100
Practice Address - Fax:650-327-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG501712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 89911Medicare UPIN