MEDICARE: DR. ROBERTO JAVIER 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	F4457	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	262900YLPS	OTHER	TX	WELLMED MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1699753426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO JAVIER RUIZ M.D.

Provider Business Mailing Address
First Line	:	1131 SE MILITARY DR
Second Line	:	STE. 117
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2801
Country	:	US
Telephone Number	:	210-924-8146
Fax Number	:	210-675-9508

Provider Business Practice Location Address
First Line	:	1131 SE MILITARY DR
Second Line	:	STE. 117
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2801
Country	:	US
Telephone Number	:	210-924-8146
Fax Number	:	210-675-9508

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	10/18/2016

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Directions to “ DR. ROBERTO JAVIER RUIZ M.D.” Practice Location

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