Provider Demographics
NPI:1568447753
Name:RUIZ, JOSE W (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:W
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1223 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2607
Mailing Address - Country:US
Mailing Address - Phone:321-725-3200
Mailing Address - Fax:321-725-4175
Practice Address - Street 1:1324 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3128
Practice Address - Country:US
Practice Address - Phone:321-725-3200
Practice Address - Fax:321-725-4175
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME29308207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260860000Medicaid
FL05388OtherBCBS OF FLORIDA
FL040014470OtherRR MEDICARE
FL040014470OtherRR MEDICARE
D51266Medicare UPIN