Healthcare Provider Details

I. General information

NPI: 1851631667
Provider Name (Legal Business Name): KENNETH RUTH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 E SHEA BLVD
SCOTTSDALE AZ
85260-6709
US

IV. Provider business mailing address

3980 E NAVIGATOR LN
PHOENIX AZ
85050-5500
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4751
  • Fax:
Mailing address:
  • Phone: 916-505-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number80566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: