Healthcare Provider Details

I. General information

NPI: 1891995189
Provider Name (Legal Business Name): JENS RUETER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WHITING HILL RD SUITE 21
BREWER ME
04412-1021
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7478
  • Fax: 207-973-7807
Mailing address:
  • Phone: 207-973-7478
  • Fax: 207-973-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR021397
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMT191485
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: