Healthcare Provider Details

I. General information

NPI: 1285711275
Provider Name (Legal Business Name): DANIEL T RUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 WEBB RD
TAMPA FL
33615-3219
US

IV. Provider business mailing address

5959 WEBB RD
TAMPA FL
33615-3219
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-0000
  • Fax: 888-481-1487
Mailing address:
  • Phone: 813-972-0000
  • Fax: 888-481-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number206940
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME127028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: