Provider Demographics
NPI:1962778399
Name:RUIZ, BETH MATHIS (PA)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MATHIS
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:901-478-0954
Mailing Address - Fax:901-478-0951
Practice Address - Street 1:1265 UNION AVENUE, 4 SHORB TOWER
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-478-9183
Practice Address - Fax:901-478-8957
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2021-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN4671363AS0400X, 363A00000X
TXPA07629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant