Healthcare Provider Details

I. General information

NPI: 1912926437
Provider Name (Legal Business Name): ROBERT RUTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8734 ORTEGA PARK DR
NAVARRE FL
32566-4139
US

IV. Provider business mailing address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

V. Phone/Fax

Practice location:
  • Phone: 850-904-2277
  • Fax: 205-618-9706
Mailing address:
  • Phone: 406-345-8901
  • Fax: 406-345-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME74008
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11461
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME74008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: