Provider Demographics
NPI:1205802956
Name:BENNETT, RUTH SHERMAN (DO)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:SHERMAN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:M
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:71 KINGSTON MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NM
Mailing Address - Zip Code:88042
Mailing Address - Country:US
Mailing Address - Phone:575-740-8169
Mailing Address - Fax:405-553-5633
Practice Address - Street 1:1313 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7251
Practice Address - Country:US
Practice Address - Phone:575-538-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1446-08207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209879709Medicaid
OK100699440MMedicaid
OK200067600AMedicaid
MO500156005Medicaid
OK242611804Medicare PIN
OK100699440MMedicaid
MO209879709Medicaid
D17401Medicare UPIN
OK800522468Medicare PIN