MEDICARE: DR. JOSE L RUIZ M.D.

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	208D00000X	General Practice Physician	ME66055	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285631408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE L RUIZ M.D.

Provider Business Mailing Address
First Line	:	11285 SW 211TH ST
Second Line	:	SUITE 304
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-2211
Country	:	US
Telephone Number	:	305-971-6883
Fax Number	:	305-971-6836

Provider Business Practice Location Address
First Line	:	11285 SW 211TH ST
Second Line	:	SUITE 304
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-2211
Country	:	US
Telephone Number	:	305-971-6883
Fax Number	:	305-971-6836

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	02/07/2019

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