MEDICARE: GREGORY D. RUTH M.D.

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	208600000X	Surgery Physician	55772	MN
2	2086S0129X	Vascular Surgery Physician	DR.0060416	CO

General Provider Information

NPI Number	:	1578505681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY D. RUTH M.D.

Provider Business Mailing Address
First Line	:	3810 NORTHDALE BLVD STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1871
Country	:	US
Telephone Number	:	813-961-1331
Fax Number	:	888-850-8316

Provider Business Practice Location Address
First Line	:	1044 S 88TH ST STE 105
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9418
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	04/15/2020

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