Provider Demographics
NPI:1710152376
Name:DUPONT, RUTH A (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:DUPONT
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 1:8360 SIERRA MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7328
Mailing Address - Country:US
Mailing Address - Phone:239-624-8330
Mailing Address - Fax:239-430-7810
Practice Address - Street 1:8360 SIERRA MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7328
Practice Address - Country:US
Practice Address - Phone:239-624-8330
Practice Address - Fax:239-430-7810
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA038223OtherGEORGIA STATE LICENSE
FLME101380OtherFLORIDA STATE LICENSE
GAB29490Medicare UPIN