MEDICARE: RUDDY E RUIZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME68400	FL
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	ME68400	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110112878	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093799041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUDDY E RUIZ MD

Provider Business Mailing Address
First Line	:	1900 DAIRY RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-4046
Country	:	US
Telephone Number	:	321-952-0494
Fax Number	:	321-952-0479

Provider Business Practice Location Address
First Line	:	1900 DAIRY RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-4046
Country	:	US
Telephone Number	:	321-952-0494
Fax Number	:	321-952-0479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	04/04/2013

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Directions to “ RUDDY E RUIZ MD” Practice Location

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