Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD470548 | PA |
N | 207YP0228X | Pediatric Otolaryngology | MT217421 | PA |
NPI | 1275944258 |
---|---|
Provider Name | Ryan Ruiz |
First Address | Philadelphia, PA 19107-3377 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 16/07/2020 |