Provider Demographics
NPI:1578627345
Name:IRIZARRY, RICARDO RUBEN (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:RUBEN
Last Name:IRIZARRY
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:PO BOX 741475
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-1475
Mailing Address - Country:US
Mailing Address - Phone:214-373-9092
Mailing Address - Fax:214-373-9250
Practice Address - Street 1:11910 GREENVILLE AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-373-9092
Practice Address - Fax:214-373-9250
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2125207L00000X
PAMD430497207L00000X
FLME 97755207L00000X
MDD0066463207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207165602Medicaid
TX207165602Medicaid