Provider Demographics
NPI:1023195310
Name:RUTZ, JOSEPH ALEXANDER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:RUTZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 RICHMOND RD APT 6302
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1208
Mailing Address - Country:US
Mailing Address - Phone:318-245-9834
Mailing Address - Fax:
Practice Address - Street 1:5911 RICHMOND RD APT 6302
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1208
Practice Address - Country:US
Practice Address - Phone:318-245-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204792207V00000X
TXP1813207V00000X
IN01074849A207V00000X
ORMD176328207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1637181Medicaid
LA1637181Medicaid