Healthcare Provider Details

I. General information

NPI: 1356410104
Provider Name (Legal Business Name): MARTIN A RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2332 BEVERLY HILLS DR
FORT WORTH TX
76114-1756
US

IV. Provider business mailing address

2332 BEVERLY HILLS DR
FORT WORTH TX
76114-1756
US

V. Phone/Fax

Practice location:
  • Phone: 817-625-4254
  • Fax: 817-378-0861
Mailing address:
  • Phone: 817-625-4254
  • Fax: 817-378-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2006-0679
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS8382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: