Provider Demographics
NPI:1366574063
Name:NELSON, RUTH GRETCHEN (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:GRETCHEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:620 N VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-7014
Mailing Address - Country:US
Mailing Address - Phone:520-325-9505
Mailing Address - Fax:
Practice Address - Street 1:CAMPUS HEALTH SERVICE
Practice Address - Street 2:UNIVERSITY OF ARIZONA 210095
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0095
Practice Address - Country:US
Practice Address - Phone:520-621-6489
Practice Address - Fax:520-621-8412
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08303208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice