Provider Demographics
NPI:1407922693
Name:RUIZ, JOSE TADEO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:TADEO
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 1:7600 OSLER DRIVE
Mailing Address - Street 2:STE 304
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-821-5758
Mailing Address - Fax:410-321-9484
Practice Address - Street 1:7600 OSLER DRIVE
Practice Address - Street 2:STE 304
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-821-5758
Practice Address - Fax:410-321-9484
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0026580208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D74424Medicare UPIN
7821Medicare ID - Type Unspecified