Provider Demographics
NPI:1629047600
Name:RUIZ, JULIO PABLO (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:PABLO
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:PO BOX 752743
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-2743
Mailing Address - Country:US
Mailing Address - Phone:901-565-0244
Mailing Address - Fax:901-565-0616
Practice Address - Street 1:6490 MOUNT MORIAH ROAD EXT
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-3729
Practice Address - Country:US
Practice Address - Phone:901-565-0244
Practice Address - Fax:901-565-0616
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25900207RN0300X
ARE0222207RN0300X
MS14580207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN052203Medicaid
1723309OtherCIGNA
AR5J496OtherBLUE CROSS BLUE SHIELD
MS0120636Medicaid
TN3086649Medicaid
AR125721001Medicaid
TN4010137OtherBLUE CROSS BLUE SHIELD
1723309OtherCIGNA
ARD73836Medicare UPIN
TN115312Medicare ID - Type UnspecifiedUNISON TENNCARE
TN052203Medicaid
AR5J496B527Medicare PIN
TN3086648Medicare ID - Type Unspecified
AR125721001Medicaid
TN3086649Medicaid