Provider Demographics
NPI:1477516797
Name:RUTHERFORD, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:RUTHERFORD
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 1:4100 MCCLELLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-2132
Mailing Address - Country:US
Mailing Address - Phone:256-235-2273
Mailing Address - Fax:256-235-2277
Practice Address - Street 1:4100 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-2132
Practice Address - Country:US
Practice Address - Phone:256-235-2273
Practice Address - Fax:256-235-2277
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.10525207Q00000X
AL00010525207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000018664Medicaid
AL051018664OtherBLUE CROSS/BLUE SHIELD
AL000018664Medicaid
ALC70375Medicare UPIN