Provider Demographics
NPI:1538126230
Name:STREETER, RUTH R (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:R
Last Name:STREETER
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 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2425
Mailing Address - Country:US
Mailing Address - Phone:904-268-5200
Mailing Address - Fax:
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2425
Practice Address - Country:US
Practice Address - Phone:904-268-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91423207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54340OtherBCBS
FL5604534OtherAETNA
FL306041OtherAVMED
FL277437200Medicaid
FLP00375351Medicare PIN
FL5604534OtherAETNA
FLA15589Medicare UPIN
FL277437200Medicaid