Provider Demographics
NPI:1346433562
Name:ODEL RUANO M D P A
Entity Type:Organization
Organization Name:ODEL RUANO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ODEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-258-3606
Mailing Address - Street 1:PO BOX 380639
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0639
Mailing Address - Country:US
Mailing Address - Phone:941-258-3606
Mailing Address - Fax:
Practice Address - Street 1:3067 TAMIAMI TRL
Practice Address - Street 2:UNIT 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6601
Practice Address - Country:US
Practice Address - Phone:941-258-3606
Practice Address - Fax:941-258-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
64255OtherBCBS FL
64255OtherBCBS FL