Provider Demographics
NPI:1821007980
Name:MOES, RUTH L (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:MOES
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 1:855 MANKATO AVENUE
Mailing Address - Street 2:PO BOX 5600
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-0006
Mailing Address - Country:US
Mailing Address - Phone:507-457-4160
Mailing Address - Fax:507-457-4160
Practice Address - Street 1:855 MANKATO AVENUE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-0006
Practice Address - Country:US
Practice Address - Phone:507-457-4484
Practice Address - Fax:507-457-4160
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33132207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34150800Medicaid
145R5MOOtherBLUE CROSS BLUE SHIELD MN
E20167Medicare UPIN