Provider Demographics
NPI:1669959649
Name:RUIZ RODRIGUEZ, JOSE IGNACIO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:IGNACIO
Last Name:RUIZ RODRIGUEZ
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 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:956-704-1717
Mailing Address - Fax:956-435-8363
Practice Address - Street 1:6801 MCPHERSON RD STE 331
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-704-1717
Practice Address - Fax:956-435-8363
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS9057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1O8519OtherPTAN