Healthcare Provider Details

I. General information

NPI: 1760542054
Provider Name (Legal Business Name): IVAN RODRIGO ZENDEJAS RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 S COTTONWOOD ST STE 650
MURRAY UT
84107-5716
US

IV. Provider business mailing address

5171 S COTTONWOOD ST STE 650
MURRAY UT
84107-5716
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0606
  • Fax: 352-265-0678
Mailing address:
  • Phone: 352-265-0606
  • Fax: 352-265-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number10757
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME108537
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9580790-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: