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Individual

MS. SHANNON ALEXANDER RUTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
130 HAYS ST, SUITE D, LULING, TX 78648-3207
(830) 875-3445
(830) 875-3765
Mailing address
130 HAYS ST, SUITE D, LULING, TX 78648-3207
(830) 875-3445
(830) 875-3765

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA05863
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
280084902
TX
Enumeration date
03/27/2008
Last updated
11/08/2012
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