Provider Demographics
NPI:1962480830
Name:RUIZ RODRIGUEZ, ORLANDO I (MD)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:I
Last Name:RUIZ RODRIGUEZ
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:PO BOX 919741
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9741
Mailing Address - Country:US
Mailing Address - Phone:218-428-4913
Mailing Address - Fax:218-436-3043
Practice Address - Street 1:1222 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:321-841-7856
Practice Address - Fax:321-843-6432
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111442174400000X
IL036-106976207RC0200X
FLME97401207RC0200X
FLME0097401207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1962480830OtherMULTIPLAN/PHCS
IL1962480830OtherHUMANA/CHOICE CARE
IL1962480830OtherUHC
IL7178107OtherAETNA
IL1962480830OtherTRICARE STANDARD
FL277819000Medicaid
IL036106976Medicaid
IL1962480830OtherMERCY HEALTH PLANS
MO1962480830Medicaid
IL3876271OtherCIGNA
IL463598OtherHEALTHLINK
IL753031110OtherTRICARE PRIME
IL809681OtherCOVENTRY NATIONAL
ILP00720332OtherRAILROAD MEDICARE
IL6032378OtherBLUECROSS BLUESHIELD
FLME97401OtherMEDICAL LICENSE
IL483954OtherGHP
MO000000470469OtherBLUECROSS BLUESHIELD
IL1962480830OtherBEECHSTREET/PPONEXT
IL753031110OtherHFN
IL76359OtherHEALTH ALLIANCE
IL1962480830OtherMERCY HEALTH PLANS
IL753031110OtherHFN
ILIL1613001Medicare PIN