Provider Demographics
NPI:1285066381
Name:JORGE RUIZ LLANES MD PA
Entity type:Organization
Organization Name:JORGE RUIZ LLANES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-647-5144
Mailing Address - Street 1:PO BOX 8006
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-8006
Mailing Address - Country:US
Mailing Address - Phone:956-647-5144
Mailing Address - Fax:956-647-5145
Practice Address - Street 1:1412 E 8TH ST
Practice Address - Street 2:SUITE-B
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6639
Practice Address - Country:US
Practice Address - Phone:956-647-5144
Practice Address - Fax:956-647-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM8300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276138600Medicaid
FL276138600Medicaid
FLI65592Medicare UPIN