Provider Demographics
NPI:1770580227
Name:DEMMEL, RUTH (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:DEMMEL
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 1:32745 ROAD 769
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-4008
Mailing Address - Country:US
Mailing Address - Phone:308-352-4078
Mailing Address - Fax:308-352-2281
Practice Address - Street 1:945 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3044
Practice Address - Country:US
Practice Address - Phone:308-352-2122
Practice Address - Fax:308-352-2281
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE13057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04122OtherBLUE CROSS
NENE13057Medicaid
NE04122OtherBLUE CROSS
NENE13057Medicaid