Provider Demographics
NPI:1083705636
Name:VALDEZ, ELIAS DAVID RUIZ (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS DAVID
Middle Name:RUIZ
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E. DAVID
Other - Middle Name:R
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-2530
Mailing Address - Country:US
Mailing Address - Phone:980-201-1340
Mailing Address - Fax:
Practice Address - Street 1:557 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4107
Practice Address - Country:US
Practice Address - Phone:704-873-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60767682207R00000X
ORMD184516207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1364884Medicaid
ORMD184516OtherOREGON LICENSE
CO379591YLB8Medicare PIN
CO1364884Medicaid