MEDICARE: DR. TIFFANY K RUTH MD

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	207P00000X	Emergency Medicine Physician	25MA06942900	NJ
2	2085R0204X	Vascular & Interventional Radiology Physician	25MA06942900	NJ
3	207P00000X	Emergency Medicine Physician	ME179498	FL
4	208D00000X	General Practice Physician	25MA06942900	NJ
5	202K00000X	Phlebology Physician	ME179498	FL

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	:	1770578221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY K RUTH MD

Provider Business Mailing Address
First Line	:	3820 NORTHDALE BLVD STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1893
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Provider Business Practice Location Address
First Line	:	2290 10TH AVE N STE 101
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/20/2026

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Directions to “ DR. TIFFANY K RUTH MD” Practice Location

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