Provider Demographics
NPI:1598709149
Name:BERNARDEZ-TAN, RUTH A (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:A
Last Name:BERNARDEZ-TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:A
Other - Last Name:BERNARDEZ-TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1915 E MAYFIELD RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2605
Mailing Address - Country:US
Mailing Address - Phone:682-276-6700
Mailing Address - Fax:682-276-6049
Practice Address - Street 1:1915 E MAYFIELD RD STE 115
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2605
Practice Address - Country:US
Practice Address - Phone:682-276-6700
Practice Address - Fax:682-276-6049
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0453219-13Medicaid