Provider Demographics
NPI:1164476727
Name:RUAS, ERNESTO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:J
Last Name:RUAS
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 1:3210 W SAN NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5951
Mailing Address - Country:US
Mailing Address - Phone:813-251-2230
Mailing Address - Fax:
Practice Address - Street 1:603 S BOULEVARD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2629
Practice Address - Country:US
Practice Address - Phone:813-259-1550
Practice Address - Fax:813-258-1287
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00473962086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL232013OtherAMERIGROUP
FL100797OtherAVMED
FL17809OtherSTAYWELL
FL03919OtherBCBS
FL4014451002OtherCIGNA
FL624558OtherAETNA
FL03919-2Medicare ID - Type Unspecified
FL100797OtherAVMED