Provider Demographics
NPI:1477711844
Name:JORGE RUIZ LLANES MD PA
Entity Type:Organization
Organization Name:JORGE RUIZ LLANES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-794-3882
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-1240
Mailing Address - Country:US
Mailing Address - Phone:352-794-3882
Mailing Address - Fax:
Practice Address - Street 1:700 SE 5TH TER
Practice Address - Street 2:SUITE 2
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4878
Practice Address - Country:US
Practice Address - Phone:352-794-3882
Practice Address - Fax:352-794-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276138600Medicaid
FL276138600Medicaid
FLU8777VMedicare PIN
FLCP405AMedicare PIN