Provider Demographics
NPI:1356736235
Name:RUZ-PAU, CARLOS ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:RUZ-PAU
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 1:700 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4924
Mailing Address - Country:US
Mailing Address - Phone:407-483-3376
Mailing Address - Fax:407-279-4005
Practice Address - Street 1:700 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-483-3376
Practice Address - Fax:407-279-4005
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134901207R00000X, 208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100583600Medicaid
FLKF348OtherFL MEDICARE