Provider Demographics
NPI:1760542054
Name:ZENDEJAS RUIZ, IVAN RODRIGO (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:RODRIGO
Last Name:ZENDEJAS RUIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5171 S COTTONWOOD ST
Mailing Address - Street 2:STE 650
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5716
Mailing Address - Country:US
Mailing Address - Phone:352-265-0606
Mailing Address - Fax:352-265-0678
Practice Address - Street 1:5171 S COTTONWOOD ST
Practice Address - Street 2:STE 650
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5716
Practice Address - Country:US
Practice Address - Phone:352-265-0606
Practice Address - Fax:352-265-0678
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2016-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL10757204F00000X
FLME108537208600000X
UT9580790-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEE869ZMedicare PIN
FL002878400Medicaid