Provider Demographics
NPI:1356410104
Name:RUIZ, MARTIN A (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
Last Name:RUIZ
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 1:2332 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-1756
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:817-378-0861
Practice Address - Street 1:2332 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1756
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0679207R00000X
TXS8382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001P94OtherBCBS NM
NM49370081Medicaid
TX8NQ455OtherBCBS
NMNM001P94OtherBCBS NM