Provider Demographics
NPI:1528069127
Name:RUIZ, HENRY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1157
Mailing Address - Country:US
Mailing Address - Phone:256-494-3033
Mailing Address - Fax:256-494-3036
Practice Address - Street 1:300 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 303
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1157
Practice Address - Country:US
Practice Address - Phone:256-494-3033
Practice Address - Fax:256-494-3036
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC74582Medicare UPIN
AL5101140002Medicare PIN