Provider Demographics
NPI:1134319783
Name:RUIZ, JOSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1172 CYPRESS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7560
Mailing Address - Country:US
Mailing Address - Phone:407-518-1810
Mailing Address - Fax:407-201-8834
Practice Address - Street 1:4301 SUN N LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2138
Practice Address - Country:US
Practice Address - Phone:863-402-3161
Practice Address - Fax:863-402-8244
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2019-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME58319207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
201309361OtherCOMMERCIAL
11246AMedicare PIN