Provider Demographics
NPI:1487040507
Name:KAGWIMA, RUTH N (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:N
Last Name:KAGWIMA
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 1:4301 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3949
Mailing Address - Country:US
Mailing Address - Phone:817-281-8275
Mailing Address - Fax:817-788-8638
Practice Address - Street 1:4301 BROWN TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-281-8275
Practice Address - Fax:817-788-8638
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine