Provider Demographics
NPI:1699336511
Name:ARCHIBALD, RUTH (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:ARCHIBALD
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 1:6962 COTTONWOOD CT NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8835
Mailing Address - Country:US
Mailing Address - Phone:507-287-8574
Mailing Address - Fax:
Practice Address - Street 1:6962 COTTONWOOD CT NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8835
Practice Address - Country:US
Practice Address - Phone:507-287-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine