Provider Demographics
NPI:1851476287
Name:SAMPSON, RUTH LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:LOUISE
Last Name:SAMPSON
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 1:403 S 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2631
Mailing Address - Country:US
Mailing Address - Phone:406-728-1985
Mailing Address - Fax:406-728-2272
Practice Address - Street 1:403 S 4TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2631
Practice Address - Country:US
Practice Address - Phone:406-728-1985
Practice Address - Fax:406-728-2272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4261207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
460000779OtherTRAVELERS' MEDICARE
MT000012730OtherBLUECROSSBLUESHIELD
MT0052351Medicaid
MT0052351Medicaid
MT000083924Medicare ID - Type Unspecified