Healthcare Provider Details

I. General information

NPI: 1376617449
Provider Name (Legal Business Name): RUTH MIZE MYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 NICOLLET COURT SUITE 207
BURNSVILLE MN
55306
US

IV. Provider business mailing address

14300 NICOLLET CT STE 207
BURNSVILLE MN
55306-8329
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-7578
  • Fax: 952-898-7592
Mailing address:
  • Phone: 952-898-7578
  • Fax: 952-898-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMED-PHYS-LIC-127159
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number49578
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number49576
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: