Provider Demographics
NPI:1124437595
Name:MOEN, RUTH RANUM (DPM)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:RANUM
Last Name:MOEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:SOREN
Other - Last Name:RANUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 S LOUISE AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6029
Mailing Address - Country:US
Mailing Address - Phone:605-504-1100
Mailing Address - Fax:
Practice Address - Street 1:6100 S LOUISE AVE STE 2100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6029
Practice Address - Country:US
Practice Address - Phone:605-504-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD240213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program