Provider Demographics
NPI:1689834350
Name:RUBY, JEANETTE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ELIZABETH
Last Name:RUBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 16TH AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3311
Mailing Address - Country:US
Mailing Address - Phone:206-328-8774
Mailing Address - Fax:206-324-6215
Practice Address - Street 1:1118 16TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3311
Practice Address - Country:US
Practice Address - Phone:206-328-8774
Practice Address - Fax:206-324-6215
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00058814101Y00000X
WAMD00027447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101Y00000XBehavioral Health & Social Service ProvidersCounselor