Healthcare Provider Details

I. General information

NPI: 1699331686
Provider Name (Legal Business Name): RUTH MARIE DUESTERHEFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOLLY HILL RD
MINERAL WELLS TX
76067-5043
US

IV. Provider business mailing address

101 HOLLY HILL RD
MINERAL WELLS TX
76067-5043
US

V. Phone/Fax

Practice location:
  • Phone: 940-463-7092
  • Fax: 940-463-7096
Mailing address:
  • Phone: 940-463-7092
  • Fax: 940-463-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT6878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: