Provider Demographics
NPI:1790730273
Name:RUIZ-HUIDOBRO, ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:RUIZ-HUIDOBRO
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 1:900 E SOUTHLAKE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6376
Mailing Address - Country:US
Mailing Address - Phone:817-421-0770
Mailing Address - Fax:817-421-4759
Practice Address - Street 1:900 E SOUTHLAKE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6376
Practice Address - Country:US
Practice Address - Phone:817-421-0770
Practice Address - Fax:817-421-4759
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2579208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO074050113Medicare ID - Type UnspecifiedMEDICARE
MOG47229Medicare UPIN