Provider Demographics
NPI:1922097583
Name:RUIZ, ROBERTO C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:C
Last Name:RUIZ
Suffix:JR
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 1:815 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5655
Mailing Address - Country:US
Mailing Address - Phone:956-383-0714
Mailing Address - Fax:956-383-4222
Practice Address - Street 1:815 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5655
Practice Address - Country:US
Practice Address - Phone:956-383-0714
Practice Address - Fax:956-383-4222
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3315208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121163303Medicaid
TX00JN98Medicare ID - Type Unspecified
TX121163303Medicaid