MEDICARE: DR. HIRAM ANTONIO RUIZ SANTIAGO II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	12825	PR
2	207ND0101X	MOHS-Micrographic Surgery Physician	12825	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26193	OTHER	PR	MEDICARE NUMBER-RCM

General Provider Information

NPI Number	:	1447249768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIRAM ANTONIO RUIZ SANTIAGO II MD

Provider Business Mailing Address
First Line	:	1845 CARR 2 STE 907
Second Line	:	BAYAMON MEDICAL PLZ
City	:	BAYAMON
State	:	PR
Zip	:	00959-7206
Country	:	US
Telephone Number	:	787-641-9585
Fax Number	:	787-641-9586

Provider Business Practice Location Address
First Line	:	1845 CARR 2 STE 907
Second Line	:	BAYAMON MEDICAL PLZ
City	:	BAYAMON
State	:	PR
Zip	:	00959-7206
Country	:	US
Telephone Number	:	787-641-9585
Fax Number	:	787-641-9586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	05/29/2015

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Directions to “ DR. HIRAM ANTONIO RUIZ SANTIAGO II MD” Practice Location

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