MEDICARE: RUTH A DUPONT M.D.

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	207Q00000X	Family Medicine Physician	ME 101380	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038223	OTHER	GA	GEORGIA STATE LICENSE
2	ME101380	OTHER	FL	FLORIDA STATE LICENSE

General Provider Information

NPI Number	:	1710152376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH A DUPONT M.D.

Provider Business Mailing Address
First Line	:	8360 SIERRA MEADOWS BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34113-7328
Country	:	US
Telephone Number	:	239-624-8330
Fax Number	:	239-430-7810

Provider Business Practice Location Address
First Line	:	8360 SIERRA MEADOWS BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34113-7328
Country	:	US
Telephone Number	:	239-624-8330
Fax Number	:	239-430-7810

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	10/06/2014

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