Provider Demographics
NPI:1629224118
Name:JOHN, RUBY SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:SAMUEL
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 KYSER WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-2783
Mailing Address - Country:US
Mailing Address - Phone:972-643-8727
Mailing Address - Fax:
Practice Address - Street 1:777 MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036
Practice Address - Country:US
Practice Address - Phone:972-643-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08711100207R00000X
TXP1334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine