Healthcare Provider Details

I. General information

NPI: 1164476727
Provider Name (Legal Business Name): ERNESTO J RUAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S BOULEVARD
TAMPA FL
33606-2629
US

IV. Provider business mailing address

3210 W SAN NICHOLAS ST
TAMPA FL
33629-5951
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-1550
  • Fax: 813-258-1287
Mailing address:
  • Phone: 813-251-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME0047396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: