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General NPI Number Information
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NPI Number | 1316049547
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Entity Type | Organization
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Legal Business Name | HEARTLAND OTOLARYNGOLOGY LLC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 1172 CYPRESS GLEN CIR
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City | KISSIMMEE
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State | FL
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Zip | 34741-7560
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Country | US
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Telephone | 407-518-1810
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Fax | 407-201-8834
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Provider Business Mailing Address
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Address Line | 1172 CYPRESS GLEN CIR
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City | KISSIMMEE
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State | FL
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Zip | 34741-7560
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Country | US
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Telephone | 407-518-1810
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Fax | 407-201-8834
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JOSE L. RUIZ
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Credential | M.D.
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Telephone | 407-518-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME0058319
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License Number State | FL
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