Provider Demographics
NPI:1992898019
Name:RUTH, WILLARD D (DO)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:D
Last Name:RUTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 WHITEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1804
Mailing Address - Country:US
Mailing Address - Phone:716-773-6181
Mailing Address - Fax:716-773-0941
Practice Address - Street 1:1870 WHITEHAVEN RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1804
Practice Address - Country:US
Practice Address - Phone:716-773-6181
Practice Address - Fax:716-773-0941
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108855208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
6400427OtherIHA
00010152701OtherUNIVERA
00050366101OtherBCBS
NY00629290Medicaid
C57974Medicare UPIN
NY00629290Medicaid