Healthcare Provider Details

I. General information

NPI: 1730189218
Provider Name (Legal Business Name): THOMAS J RUANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 SUNSET LAKE BLVD SUITE 403
VENICE FL
34292-7551
US

IV. Provider business mailing address

2234 COLONIAL BLVD MANAGED CARE DEPT
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-3351
  • Fax: 941-485-7677
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0062037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: