Provider Demographics
NPI:1699753426
Name:RUIZ, ROBERTO JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:JAVIER
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1131 SE MILITARY DR
Mailing Address - Street 2:STE. 117
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2801
Mailing Address - Country:US
Mailing Address - Phone:210-924-8146
Mailing Address - Fax:210-675-9508
Practice Address - Street 1:1131 SE MILITARY DR
Practice Address - Street 2:STE. 117
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2801
Practice Address - Country:US
Practice Address - Phone:210-924-8146
Practice Address - Fax:210-675-9508
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4457208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX262900YLPSOtherWELLMED MEDICARE
TX1225328-07OtherWELLMED MEDICAID
TX262900YLPSOtherWELLMED MEDICARE
TX122532806Medicaid
TX611723Medicare PIN