MEDICARE: RUTH BEAR LD

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	133V00000X	Registered Dietitian	027	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528057460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH BEAR LD

Provider Business Mailing Address
First Line	:	1505 VISTA LARGA CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2646
Country	:	US
Telephone Number	:	505-265-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 UNIVERSITY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-1734
Country	:	US
Telephone Number	:	505-272-8062
Fax Number	:

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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Directions to “ RUTH BEAR LD” Practice Location

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