MEDICARE: RUTH HASKINS, MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G064514	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3065000	OTHER	CA	STATE, CORPORATION NUMBER

General Provider Information

NPI Number	:	1245409598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTH HASKINS, MD, INC.

Provider Business Mailing Address
First Line	:	3444 SMOKEY MOUNTAIN CIR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7326
Country	:	US
Telephone Number	:	916-941-0779
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 CREEKSIDE DR
Second Line	:	SUITE 103
City	:	FOLSOM
State	:	CA
Zip	:	95630-3490
Country	:	US
Telephone Number	:	916-817-2649
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. RUTH ELLEN HASKINS
Credential	:	MD
Telephone Number	:	916-817-2649

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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