Provider Demographics
NPI:1184650087
Name:RUIZ, JORGE G (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:G
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:054-985-7074
Practice Address - Street 1:3341 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5419
Practice Address - Country:US
Practice Address - Phone:954-265-3982
Practice Address - Fax:954-893-6581
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME65296207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117834300Medicaid
FLG62119Medicare UPIN
FL2527472-00Medicaid