Individual
HOLLI K RUBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
504 NW 10TH AVE., AVA, MO 65608-1359
(417) 683-4831
(417) 683-1602
Mailing address
PO BOX 1359, AVA, MO 65608-1359
(417) 683-4831
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
118003
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080174612
RAILROAD MEDICARE
—
01
—
148980
BCBS
—
05
—
243912714
—
MO
01
—
389677
HEALTHLINK
—
Enumeration date
06/16/2006
Last updated
10/26/2015
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