Provider Demographics
NPI:1093799041
Name:RUIZ, RUDDY E (MD)
Entity Type:Individual
Prefix:
First Name:RUDDY
Middle Name:E
Last Name:RUIZ
Suffix:
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 1:1900 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4046
Mailing Address - Country:US
Mailing Address - Phone:321-952-0494
Mailing Address - Fax:321-952-0479
Practice Address - Street 1:1900 DAIRY RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4046
Practice Address - Country:US
Practice Address - Phone:321-952-0494
Practice Address - Fax:321-952-0479
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68400207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379019300Medicaid
FL110112878OtherRR MEDICARE
FL379019300Medicaid
FL110112878OtherRR MEDICARE