Provider Demographics
NPI:1407822331
Name:WILSON, RUTH D (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:980 TRANCAS ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2933
Mailing Address - Country:US
Mailing Address - Phone:707-255-3583
Mailing Address - Fax:707-255-3579
Practice Address - Street 1:980 TRANCAS ST
Practice Address - Street 2:SUITE 12
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2933
Practice Address - Country:US
Practice Address - Phone:707-255-3583
Practice Address - Fax:707-255-3579
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG080389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52013Medicare UPIN