Provider Demographics
NPI:1134374960
Name:RUTH R. WILEY, D.O., P.A.
Entity type:Organization
Organization Name:RUTH R. WILEY, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O., P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:REPOSA
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-926-4118
Mailing Address - Street 1:851 WEST TERRELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3161
Mailing Address - Country:US
Mailing Address - Phone:817-926-4118
Mailing Address - Fax:817-926-4362
Practice Address - Street 1:851 W TERRELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3161
Practice Address - Country:US
Practice Address - Phone:817-926-4118
Practice Address - Fax:817-926-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty