MEDICARE: CALIXTO J RUIBAL MD PA

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	207Q00000X	Family Medicine Physician	J9368	TX
2	207Q00000X	Family Medicine Physician	H0743	TX
3	207R00000X	Internal Medicine Physician	K1780	TX
4	207RC0000X	Cardiovascular Disease Physician	E6843	TX
5	207RG0100X	Gastroenterology Physician	E9383	TX
6	207VG0400X	Gynecology Physician	E3766	TX
7	208000000X	Pediatrics Physician	K6707	TX
8	208600000X	Surgery Physician	G7822	TX
9	208800000X	Urology Physician	L8425	TX
10	261Q00000X	Clinic/Center	G0921	TX
11	207Q00000X	Family Medicine Physician	G0921	TX

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

General Provider Information

NPI Number	:	1518012558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIXTO J RUIBAL MD PA

Provider Business Mailing Address
First Line	:	7109 LAWNDALE ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77023-4248
Country	:	US
Telephone Number	:	832-200-1646
Fax Number	:	832-200-1660

Provider Business Practice Location Address
First Line	:	7109 LAWNDALE ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77023-4248
Country	:	US
Telephone Number	:	832-200-1646
Fax Number	:	832-200-1660

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CALIXTO JORGE RUIBAL
Credential	:	MD
Telephone Number	:	832-200-1646

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/12/2011

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