Provider Demographics
NPI:1104923374
Name:RUAS, VIRGINIA L (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:RUAS
Suffix:
Gender:F
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6163
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:2600 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4750
Practice Address - Country:US
Practice Address - Phone:817-347-4600
Practice Address - Fax:817-347-4639
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96333208000000X
NY2503172080A0000X
TXP2919208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 96333OtherMEDICAL LICENSE
NY03053945Medicaid
FLBR9934488OtherDEA #
TXTXB152485Medicare PIN