Provider Demographics
NPI:1669433520
Name:BLAIR, RUTH ANN (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:BLAIR
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-843-4555
Mailing Address - Fax:501-843-7081
Practice Address - Street 1:2037 WEST MAIN
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-843-4555
Practice Address - Fax:501-843-7081
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2023207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136707001Medicaid
G91835Medicare UPIN
5L159Medicare ID - Type Unspecified