Provider Demographics
NPI:1124093943
Name:RUTH, HARRY ROY (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ROY
Last Name:RUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4038
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:217-277-2253
Practice Address - Street 1:1107 COLLEGE AVE
Practice Address - Street 2:STE 2
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2664
Practice Address - Country:US
Practice Address - Phone:217-228-3377
Practice Address - Fax:217-228-2657
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068434207Y00000X
MOR7A18207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068434Medicaid
IL040005819Medicare PIN
IL036068434Medicaid