Provider Demographics
NPI:1962408351
Name:RUIZ, JIMMY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:JOSEPH
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 1:2729 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1042
Mailing Address - Country:US
Mailing Address - Phone:215-672-2229
Mailing Address - Fax:
Practice Address - Street 1:2729 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1042
Practice Address - Country:US
Practice Address - Phone:215-672-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419490207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070955Medicare PIN