Provider Demographics
NPI:1033161351
Name:MENESES-TAYLOR, RUTH (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MENESES-TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N HIGHWAY 19A
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2228
Mailing Address - Country:US
Mailing Address - Phone:352-383-1245
Mailing Address - Fax:352-383-4401
Practice Address - Street 1:3801 N HIGHWAY 19A
Practice Address - Street 2:SUITE 400
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2228
Practice Address - Country:US
Practice Address - Phone:352-383-1245
Practice Address - Fax:352-383-4401
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048255200Medicaid
FL04231ZMedicare ID - Type Unspecified
FL048255200Medicaid