Provider Demographics
NPI:1093775496
Name:LONG, RUTH B (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:B
Last Name:LONG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1113 MURFREESBORO RD
Mailing Address - Street 2:STE 319
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-7312
Mailing Address - Country:US
Mailing Address - Phone:615-790-0567
Mailing Address - Fax:615-595-8030
Practice Address - Street 1:1113 MURFREESBORO RD
Practice Address - Street 2:STE 319
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-7312
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:615-595-8030
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-12-10
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Provider Licenses
StateLicense IDTaxonomies
TN16627208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023305Medicaid
TNA98716Medicare UPIN