Provider Demographics
NPI:1245945351
Name:STRAW, RUBY
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:STRAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-3535
Mailing Address - Country:US
Mailing Address - Phone:501-687-7285
Mailing Address - Fax:
Practice Address - Street 1:44 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-3535
Practice Address - Country:US
Practice Address - Phone:501-687-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR924069729172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver