Provider Demographics
NPI:1447310685
Name:RUIZ RIVERA, RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:RUIZ RIVERA
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 1:11761 BEACH BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6699
Mailing Address - Country:US
Mailing Address - Phone:904-642-3304
Mailing Address - Fax:904-642-8375
Practice Address - Street 1:11761 BEACH BLVD STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6699
Practice Address - Country:US
Practice Address - Phone:904-642-3304
Practice Address - Fax:904-642-8375
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13867208D00000X
FLACN901208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84348Medicare ID - Type Unspecified
PRH55703Medicare UPIN