Provider Demographics
NPI:1285619072
Name:JOHNSON, RUTH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1417
Mailing Address - Country:US
Mailing Address - Phone:716-937-6743
Mailing Address - Fax:716-937-6453
Practice Address - Street 1:13500 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1417
Practice Address - Country:US
Practice Address - Phone:716-937-6743
Practice Address - Fax:716-937-6453
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine