Provider Demographics
NPI:1801035969
Name:RUTHERFORD, JEREMIAH SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:SCOTT
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1808 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2724
Mailing Address - Country:US
Mailing Address - Phone:479-964-4178
Mailing Address - Fax:479-964-5910
Practice Address - Street 1:1808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2724
Practice Address - Country:US
Practice Address - Phone:479-964-4178
Practice Address - Fax:479-964-5910
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26821207R00000X
ARC-10897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine