Provider Demographics
NPI:1407099484
Name:RUIZ, ALAN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:PATRICK
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 1:45 GREEN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3509
Mailing Address - Country:US
Mailing Address - Phone:860-774-1255
Mailing Address - Fax:860-779-2059
Practice Address - Street 1:45 GREEN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3509
Practice Address - Country:US
Practice Address - Phone:860-774-1255
Practice Address - Fax:860-779-2059
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53155207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program