Provider Demographics
NPI:1285631408
Name:RUIZ, JOSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
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 1:11285 SW 211TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2211
Mailing Address - Country:US
Mailing Address - Phone:305-971-6883
Mailing Address - Fax:305-971-6836
Practice Address - Street 1:11285 SW 211TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2211
Practice Address - Country:US
Practice Address - Phone:305-971-6883
Practice Address - Fax:305-971-6836
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66055208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373801903Medicaid
FLF87724Medicare UPIN
FL25652XMedicare PIN