MEDICARE: JACQUELINE R CARRUTHERS 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	174400000X	Specialist	K7429	TX
2	207R00000X	Internal Medicine Physician	K7429	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972504967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE R CARRUTHERS M.D.

Provider Business Mailing Address
First Line	:	600 N SAM HOUSTON PKWY W STE 650
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-4336
Country	:	US
Telephone Number	:	281-654-4500
Fax Number	:	281-654-4501

Provider Business Practice Location Address
First Line	:	600 N SAM HOUSTON PKWY W STE 650
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-4336
Country	:	US
Telephone Number	:	281-654-4500
Fax Number	:	281-654-4501

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/05/2024

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