Provider Demographics
NPI:1184662710
Name:RUIZ, FERNANDO J (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:J
Last Name:RUIZ
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:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:443 HEYMANN BLVD
Practice Address - Street 2:STE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2630
Practice Address - Country:US
Practice Address - Phone:337-289-8429
Practice Address - Fax:337-289-8431
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.11816R207RC0000X
LA11816R207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1481521Medicaid
LA4M992F942Medicare PIN
LA433008YJQDMedicare PIN
LA1481521Medicaid