Healthcare Provider Details

I. General information

NPI: 1124093943
Provider Name (Legal Business Name): HARRY ROY RUTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 COLLEGE AVE STE 2
QUINCY IL
62301-2664
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 217-228-3377
  • Fax: 217-228-2657
Mailing address:
  • Phone: 217-222-6550
  • Fax: 217-277-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036068434
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR7A18
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: