Provider Demographics
NPI:1770841223
Name:CARRUTH, CHARLES ERIC (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ERIC
Last Name:CARRUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MCFARLAND CIR N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1809
Mailing Address - Country:US
Mailing Address - Phone:205-345-7000
Mailing Address - Fax:205-343-6700
Practice Address - Street 1:208 MCFARLAND CIR N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1809
Practice Address - Country:US
Practice Address - Phone:205-345-7000
Practice Address - Fax:205-343-6700
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL448052085R0202X, 2085R0204X
TNMD00000526472085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology