Provider Demographics
NPI:1891258257
Name:RUIZ, COLBY SAMUELSON (MD)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:SAMUELSON
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:COLBY
Other - Last Name:SAMUELSON-RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 N PATTERSON ST STE 230
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2512
Mailing Address - Country:US
Mailing Address - Phone:229-259-4369
Mailing Address - Fax:
Practice Address - Street 1:2409 N PATTERSON ST STE 230
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2512
Practice Address - Country:US
Practice Address - Phone:229-259-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1003042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery