Provider Demographics
NPI:1578891420
Name:RUIZ, SARA POPE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:POPE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:CATHERINE
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 HALTON VILLAGE CIR STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6832
Mailing Address - Country:US
Mailing Address - Phone:864-234-1433
Mailing Address - Fax:864-286-1462
Practice Address - Street 1:105 HALTON VILLAGE CIR STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6832
Practice Address - Country:US
Practice Address - Phone:864-234-1433
Practice Address - Fax:864-286-1462
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82285207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC822854Medicaid