Provider Demographics
NPI:1063478154
Name:CARRASCO, RUY (MD)
Entity Type:Individual
Prefix:DR
First Name:RUY
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7940 SHOAL CREEK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7589
Mailing Address - Country:US
Mailing Address - Phone:512-494-4000
Mailing Address - Fax:512-494-4024
Practice Address - Street 1:5301 DAVIS LN STE 200A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4062
Practice Address - Country:US
Practice Address - Phone:512-494-4000
Practice Address - Fax:512-494-4090
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM15632080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176173605Medicaid
TX176173606Medicaid
TXI41338Medicare UPIN