MEDICARE: JACQUELINE R CARRUTHERS, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	K7429	TX

General Provider Information

NPI Number	:	1306027867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE R CARRUTHERS, MD, PA

Provider Business Mailing Address
First Line	:	PO BOX 38598
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77238-8598
Country	:	US
Telephone Number	:	713-694-6390
Fax Number	:	713-694-5331

Provider Business Practice Location Address
First Line	:	7929 NORTH SHEPHERD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-6346
Country	:	US
Telephone Number	:	713-694-6390
Fax Number	:	713-694-5331

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE R. CARRUTHERS
Credential	:	M.D.
Telephone Number	:	713-694-6390

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	03/12/2012

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