MEDICARE: JOSE LUIS RUIZ 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	ME066055	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	:	1780864991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE LUIS RUIZ MD PA

Provider Business Mailing Address
First Line	:	11285 SW 211TH ST
Second Line	:	STE 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	:	STE 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	:	DIRECTOR
Name	:	JOSE L RUIZ
Credential	:	MD
Telephone Number	:	305-971-6883

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	04/27/2015

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