=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477711844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JORGE RUIZ LLANES MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2008
-----------------------------------------------------
Last Update Date | 01/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 SE 5TH TER SUITE 2
-----------------------------------------------------
City | CRYSTAL RIVER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34429-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-794-3882
-----------------------------------------------------
Fax | 352-794-3883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1240
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34460-1240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-794-3882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JORGE RUIZ LLANES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 352-794-3882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME94400
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------