Provider Demographics
NPI:1164661989
Name:WILFONG, M ELIZABETH RUIZ (DO)
Entity Type:Individual
Prefix:DR
First Name:M ELIZABETH
Middle Name:RUIZ
Last Name:WILFONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ELIZABETH
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2421
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1400
Mailing Address - Country:US
Mailing Address - Phone:830-258-6237
Mailing Address - Fax:830-315-1366
Practice Address - Street 1:575 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:830-258-6237
Practice Address - Fax:830-315-1366
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3386207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204328301Medicaid