MEDICARE: DR. RUTH DE GUZMAN HENSON 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	ME115429	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	:	1467692194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH DE GUZMAN HENSON MD

Provider Business Mailing Address
First Line	:	12780 RACE TRACK RD STE 400
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1395
Country	:	US
Telephone Number	:	813-321-6262
Fax Number	:	813-443-8150

Provider Business Practice Location Address
First Line	:	12780 RACE TRACK RD
Second Line	:	SUITE 400
City	:	TAMPA
State	:	FL
Zip	:	33626-1395
Country	:	US
Telephone Number	:	813-321-6262
Fax Number	:	813-443-8150

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

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	03/30/2022

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