Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | ME74008 | FL |
N | 207Q00000X | Family Doctor | 11461 | MT |
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME74008 | FL |
NPI | 1912926437 |
---|---|
Provider Name | Robert Ruth |
First Address | Glendive, MT 59330-2053 |
Second Address | Navarre, FL 32566-4139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273228900 | (05) | FL |
G66842 | (02) | FL |