Provider Demographics
NPI:1164433595
Name:RUIZ, HIRAM ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRAM
Middle Name:ANTONIO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HIRAM
Other - Middle Name:ANTONIO
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1025
Mailing Address - Country:US
Mailing Address - Phone:787-878-4849
Mailing Address - Fax:787-878-7760
Practice Address - Street 1:CAYETANO COLL Y TOSTE SUITE 103
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-4849
Practice Address - Fax:787-878-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78101Medicare UPIN
PR95036Medicare ID - Type Unspecified