Provider Demographics
NPI:1407544000
Name:RUIZ, TIMOTHY LOGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LOGAN
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 1:4057 BURNETT-WOMACK BLDG CB#7050
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-843-6188
Mailing Address - Fax:919-966-8440
Practice Address - Street 1:4057 BURNETT-WOMACK BLDG CB#7050
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-843-6188
Practice Address - Fax:919-966-8440
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC316248390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program