Provider Demographics
NPI:1790957538
Name:CALDERON COLLADO, RUTH M (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:M
Last Name:CALDERON COLLADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4189
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-4189
Mailing Address - Country:US
Mailing Address - Phone:561-406-6080
Mailing Address - Fax:954-363-9663
Practice Address - Street 1:819 N CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5027
Practice Address - Country:US
Practice Address - Phone:407-288-8242
Practice Address - Fax:407-490-1309
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17062208D00000X
FLACN695208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFC5712218OtherDEA CERTIFICATE