Healthcare Provider Details

I. General information

NPI: 1356357412
Provider Name (Legal Business Name): JEFFERY V. RUZICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W COUNTRY CLUB RD
ROSWELL NM
88201-5209
US

IV. Provider business mailing address

PO BOX 10730
WESTMINSTER CA
92685-0730
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-4611
  • Fax: 575-624-4600
Mailing address:
  • Phone: 562-809-3548
  • Fax: 562-468-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number192910
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: