Provider Demographics
NPI:1760603948
Name:RUTTMAN, CAMERON REY (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:REY
Last Name:RUTTMAN
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 1:1140 BUSINESS CENTER DRIVE
Mailing Address - Street 2:400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043
Mailing Address - Country:US
Mailing Address - Phone:713-464-1981
Mailing Address - Fax:713-464-1131
Practice Address - Street 1:1140 BUSINESS CENTER DRIVE
Practice Address - Street 2:400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043
Practice Address - Country:US
Practice Address - Phone:713-464-1981
Practice Address - Fax:713-464-1131
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6860208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188903201Medicaid
TX8AG970OtherBCBSTX
TXP00443076OtherMEDICARE RR
TXP00443076OtherMEDICARE RR