Healthcare Provider Details

I. General information

NPI: 1205918182
Provider Name (Legal Business Name): ROBERT ERIC RUIZ MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

67 MADISON AVE APT 209
MEMPHIS TN
38103-6101
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5437
  • Fax:
Mailing address:
  • Phone: 734-883-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME108507
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number62147
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME108507
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberME108507
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number62147
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number62147
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: