Provider Demographics
NPI:1710079835
Name:RUTLAND, BETH MILLER (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MILLER
Last Name:RUTLAND
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:MASTIN 617
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7790
Practice Address - Fax:251-471-7715
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26417207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913240Medicaid
MS01200018Medicaid
AL100552Medicaid
AL51545954OtherBC BS
AL51545686OtherBCBS-2451 FILLINGIM ST
AL100555Medicaid
AL100553Medicaid
AL51545955OtherBC BS
AL51545953OtherBC BS
AL100555Medicaid
AL51545953OtherBC BS