Provider Demographics
NPI:1053393132
Name:RUTLEDGE, ELIZABETH WOOTEN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WOOTEN
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11410 JOLLYVILLE ROAD
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4093
Mailing Address - Country:US
Mailing Address - Phone:512-231-1444
Mailing Address - Fax:512-231-1470
Practice Address - Street 1:511 OAKWOOD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4007
Practice Address - Country:US
Practice Address - Phone:512-231-1444
Practice Address - Fax:512-231-1470
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4462208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB26074Medicare UPIN
TX834576Medicare ID - Type Unspecified