Provider Demographics
NPI:1891071767
Name:RUIZ, ANTONIO JR (PA)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 N INTERSTATE 27
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-3937
Mailing Address - Country:US
Mailing Address - Phone:806-296-2444
Mailing Address - Fax:
Practice Address - Street 1:1208 N INTERSTATE 27
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-3937
Practice Address - Country:US
Practice Address - Phone:806-296-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant