Provider Demographics
NPI:1336123611
Name:RUTH, PAUL ANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDY
Last Name:RUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 36TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2007
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7989
Practice Address - Street 1:5109 36TH AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2007
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7989
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5T429RUOtherBLUE CROSS
MNA009OtherCHAMPUS
MNHP29844OtherHEALTH PARTNERS
MN555707OtherARAZ
MN844563000Medicaid
MN01-13065OtherMEDICA
MN116213Medicaid
MN20177OtherSIOUX VALLEY
MN5T429RUMedicaid
IA959544Medicaid
MNMH9041000380OtherPREFERRED ONE
MN555707OtherARAZ
MN5T429RUOtherBLUE CROSS
MN5T429RUMedicaid
MNHP29844OtherHEALTH PARTNERS
IA959544Medicaid