Healthcare Provider Details

I. General information

NPI: 1225082415
Provider Name (Legal Business Name): JEFFREY LYNN RUTHFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 S THREE NOTCH ST
ANDALUSIA AL
36420-5325
US

IV. Provider business mailing address

849 S THREE NOTCH ST
ANDALUSIA AL
36420-5325
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-8466
  • Fax: 334-222-9811
Mailing address:
  • Phone: 334-222-8466
  • Fax: 334-222-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-084412
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: