Healthcare Provider Details

I. General information

NPI: 1235305954
Provider Name (Legal Business Name): HARRY R. RUTH, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 COLLEGE AVE SUITE 2
QUINCY IL
62301-2664
US

IV. Provider business mailing address

1107 COLLEGE AVE SUITE 2
QUINCY IL
62301-2664
US

V. Phone/Fax

Practice location:
  • Phone: 217-228-3377
  • Fax: 217-228-2657
Mailing address:
  • Phone: 217-228-3377
  • Fax: 217-228-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number036068434
License Number StateIL

VIII. Authorized Official

Name: MS. MARCA JANE OWENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 217-228-3377