Provider Demographics
NPI:1215258876
Name:PUMPHREY-RUIZ, DARA N (MD)
Entity type:Individual
Prefix:DR
First Name:DARA
Middle Name:N
Last Name:PUMPHREY-RUIZ
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 5304
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-5304
Mailing Address - Country:US
Mailing Address - Phone:888-982-7956
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST STE 2600
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1900
Practice Address - Country:US
Practice Address - Phone:888-982-7956
Practice Address - Fax:617-449-9596
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250577432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry