Provider Demographics
NPI:1942302625
Name:CAUSIN, PASTOR RUIZ JR (MD)
Entity Type:Individual
Prefix:
First Name:PASTOR
Middle Name:RUIZ
Last Name:CAUSIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5051 E LINCOLN ST
Mailing Address - Street 2:10-A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2416
Mailing Address - Country:US
Mailing Address - Phone:316-683-8849
Mailing Address - Fax:316-260-2611
Practice Address - Street 1:3223 N WEBB RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8175
Practice Address - Country:US
Practice Address - Phone:316-609-3020
Practice Address - Fax:316-609-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-29554204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105406Medicare ID - Type Unspecified
KSB46886Medicare UPIN