Provider Demographics
NPI:1538145552
Name:DECKER, RUTH A (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:DECKER
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 1:224 S WOODS MILL RD
Mailing Address - Street 2:STE. 252 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-469-1300
Mailing Address - Fax:314-878-7661
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:STE. 252 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-469-1300
Practice Address - Fax:314-878-7661
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6H10208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000501Medicare ID - Type Unspecified
F08485Medicare UPIN
MO005015479Medicare PIN