Provider Demographics
NPI:1821089491
Name:SMOTHERS, RUTH L (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:L
Last Name:SMOTHERS
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 1:1011 SURREY STREET
Mailing Address - Street 2:PO BOX 91450
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-1450
Mailing Address - Country:US
Mailing Address - Phone:337-289-1952
Mailing Address - Fax:337-289-1954
Practice Address - Street 1:1011 SURREY STREET
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70509-1450
Practice Address - Country:US
Practice Address - Phone:337-289-1952
Practice Address - Fax:337-289-1954
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08910R207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB708988OtherBLUE CROSS
LA1920274Medicaid
LAP00234922OtherRR MEDICARE
LA5N695CR18Medicare ID - Type Unspecified
LA1920274Medicaid