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General NPI Number Information
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NPI Number | 1174840078
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Entity Type | Individual
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Provider Name | RENEE RUTH MINIRTH M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2010
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 1030 JEFFERSON AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2127
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Country | US
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Telephone | 512-779-9692
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Fax |
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Provider Business Mailing Address
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Address Line | 3576 OAKLEY AVE
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City | MEMPHIS
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State | TN
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Zip | 38111-6142
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Country | US
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Telephone | 512-779-9692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2084P0800X
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License Number State | TN
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