=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710152376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH A DUPONT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 10/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8360 SIERRA MEADOWS BLVD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34113-7328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-8330
-----------------------------------------------------
Fax | 239-430-7810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8360 SIERRA MEADOWS BLVD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34113-7328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-624-8330
-----------------------------------------------------
Fax | 239-430-7810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME 101380
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------