Healthcare Provider Details

I. General information

NPI: 1629047600
Provider Name (Legal Business Name): JULIO PABLO RUIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 MOUNT MORIAH ROAD EXT SUITE 200
MEMPHIS TN
38115-3729
US

IV. Provider business mailing address

PO BOX 752743
MEMPHIS TN
38175-2743
US

V. Phone/Fax

Practice location:
  • Phone: 901-565-0244
  • Fax: 901-565-0616
Mailing address:
  • Phone: 901-565-0244
  • Fax: 901-565-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25900
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE0222
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number14580
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: