Individual
RUTH D MAYFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
301 N 8TH ST, PAV4A, SPRINGFIELD, IL 62701-1041
(217) 545-0702
(217) 545-7305
Mailing address
PO BOX 19655, SPRINGFIELD, IL 62794-9655
(217) 545-0702
(217) 545-7305
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
036105117
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105117
—
IL
Enumeration date
09/23/2005
Last updated
07/20/2010
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