Provider Demographics
NPI:1528273281
Name:RUIZ, MARILYN (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14001 SHADOW GLEN BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3386
Mailing Address - Country:US
Mailing Address - Phone:512-272-4451
Mailing Address - Fax:512-590-7319
Practice Address - Street 1:14001 SHADOW GLEN BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3386
Practice Address - Country:US
Practice Address - Phone:512-272-4451
Practice Address - Fax:512-590-7319
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN0419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315528Medicare PIN