Provider Demographics
NPI:1346353273
Name:RODRIGUEZ - RUIZ, MARTHA (DO)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:RODRIGUEZ - RUIZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:RODRIGUEZ - RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:7416 RUSTON LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5701
Mailing Address - Country:US
Mailing Address - Phone:214-534-1652
Mailing Address - Fax:972-556-0485
Practice Address - Street 1:1017 W HEBRON PKWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1113
Practice Address - Country:US
Practice Address - Phone:972-939-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI21422Medicare UPIN
NY8C9185Medicare ID - Type UnspecifiedMEDICAL PROVIDER NUMBER