MEDICARE: DR. PAUL ANDY RUTH M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	24848	MN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5T429RU	OTHER	MN	BLUE CROSS
2	A009	OTHER	MN	CHAMPUS
3	HP29844	OTHER	MN	HEALTH PARTNERS
4	555707	OTHER	MN	ARAZ
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	01-13065	OTHER	MN	MEDICA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	20177	OTHER	MN	SIOUX VALLEY
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MH9041000380	OTHER	MN	PREFERRED ONE

NPI Number	:	1336123611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ANDY RUTH M.D.

Provider Business Mailing Address
First Line	:	5109 36TH AVE N
Second Line	:
City	:	CRYSTAL
State	:	MN
Zip	:	55422-2007
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7989

Provider Business Practice Location Address
First Line	:	5109 36TH AVE N
Second Line	:
City	:	CRYSTAL
State	:	MN
Zip	:	55422-2007
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	10/20/2020