Provider Demographics
NPI:1912937384
Name:RUIZ, VICTOR H (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:H
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 633536
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0036
Mailing Address - Country:US
Mailing Address - Phone:314-878-0163
Mailing Address - Fax:314-878-4562
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 450S
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-434-2454
Practice Address - Fax:314-576-8176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO36563208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208476804Medicaid
MO208476804Medicaid
MO000000616Medicare ID - Type Unspecified