Provider Demographics
NPI:1790852341
Name:RUTHER, DAVID LEWIS III (DOM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:RUTHER
Suffix:III
Gender:M
Credentials:DOM
Other - Prefix:PROF
Other - First Name:DAVID
Other - Middle Name:LEWIS
Other - Last Name:RUTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:1892 PLAZA DEL SUR DR # A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6043
Mailing Address - Country:US
Mailing Address - Phone:505-988-8017
Mailing Address - Fax:505-988-8018
Practice Address - Street 1:1892 PLAZA DEL SUR DR # A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6043
Practice Address - Country:US
Practice Address - Phone:505-988-8017
Practice Address - Fax:505-988-8018
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM787RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist