Provider Demographics
NPI:1841281177
Name:RUIZ, MARIO A (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:RUIZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3315 COLORADO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6884
Mailing Address - Country:US
Mailing Address - Phone:940-320-1708
Mailing Address - Fax:940-565-5457
Practice Address - Street 1:3315 COLORADO BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6884
Practice Address - Country:US
Practice Address - Phone:940-320-1708
Practice Address - Fax:940-565-5457
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-12-17
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Provider Licenses
StateLicense IDTaxonomies
TXK2993207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
390008040OtherRR MEDICARE
TX132484008Medicaid
TX132484008Medicaid